(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Report of the Health Department of the Panama Canal for the calendar year"

REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1932 

Gift of the Panama Canal Museum 




J. F. SILER 

Colonel, Medical Corps, United States Army 
CHIEF HEALTH OFFICER 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA CANAL PRESS 

MOUNT HOPE, C.Z. 

1933 



REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1932 




J. F. SILER 

Colonel, Medical Corps, United States Army 
CHIEF HEALTH OFFICER 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA CANAL PRESS 
MOUNT HOPE, C.Z. 

1933 




For copies of this publication address The Panama Canal, Washington, D.C., or Balboa 
Heights, Canal Zone. 



CONTENTS 

Page 

Title 1 

Organization and activities 5 

Personnel 5 

Financial statements 8 

Vital statistics, populations of the Canal Zone, Panama City, and Colon 11 

General death rates, all causes, and from disease only 12 

Canal Zone 12 

Panama City 13 

Colon 13 

Birth rates 14 

Canal Zone 14 

Panama City 15 

Colon 16 

Infant mortality rates, Canal Zone, Panama City, and Colon 16 

Principal causes of death 18 

Canal Zone - 18 

Panama City 18 

Colon 19 

Acute transmissible diseases reported 20 

Vital statistics, Panama Canal employees 21 

Death rates, all causes 22 

Death rates, disease only 22 

Admission rates to hospitals and quarters 24 

Principal causes of admission to hospital 24 

Noneffective rates, all causes 25 

Admission rates, malaria 25 

Death rates, malaria 27 

Division of Hospitals, Dispensaries, and Charities 27 

Annual Report, Gorgas Hospital 28 

Annual Report, Board of Health Laboratory 28 

Annual Report, Colon Hospital 35 

Annual Report, Corozal Hospital 36 

Annual Report, Palo Seco Leper Colony 38 

Division of Sanitation 40 

Special projects undertaken in 1932 40 

Medical care of the population in the Madden Dam area 40 

Drainage projects 40 

Malaria in settlers (colored alien) living in the Canal Zone 41 

Seasonal mosquito pests 41 

Mosquitoes common to the Isthmus 42 

Trypanosomiasis in animals 45 

Annual Report, Health Officer, Panama City 45 

Annual Report, Health Officer, Cristobal-Colon 47 



CONTENTS— Continued 

Page 

Annual Report, Division of Quarantine 49 

Annual Report of the District Nurse for the Pacific side 49 

Medical examination of school children 50 

General Tables: 

1. Discharges from hospitals, deaths, and noneffective rates for em- 

ployees 51 

2. Causes of deaths of employees arranged with reference to color, 

age, and length of residence on Isthmus 52 

3 Deaths and death rates of residents of the Canal Zone and the 

cities of Panama and Colon 54 

4. Deaths of residents of the Canal Zone and the cities of Panama and 

Colon, by cause, sex, color, and age 56 

5. Deaths of residents of the Canal Zone and the cities of Panama 

and Colon, by place of residence, absolute numbers and 
annual rates per 1,000 62 

6. Deaths of nonresidents by cause, sex, color, and age 68 

7. Statistics regarding American employees and their families 70 

8. Discharges and deaths in hospitals of The Panama Canal, absolute 

numbers 72 

8-A. Discharges and deaths in hospitals of The Panama Canal, rates 

per 1 ,000 population 82 

9. Consolidated hospital and colony report 92 

10. Number of days hospital treatment furnished, and average num- 

ber in hospital each day of the various classes of patients 93 

11. Consolidated admission report, hospitals and dispensaries. -J 93 

12. Report of dispensaries 94 

13. Average number of days in hospitals and quarters for each ad- 

mission, employees only 94 



CALENDAR YEAR REPORT, 1932 
HEALTH DEPARTMENT 

General economic conditions are such at present that drastic curtail- 
ment of the scope of this report is necessary. It will therefore be 
confined very largely to a presentation of such statistical tables and 
analyses of vital statistics as will permit public health workers to ob- 
tain statistics for 1932. Vital statistics for all previous years of record 
and illustrative graphs to show trend, are incorporated in the annual 
report for 1931 and antecedent ones. 

ORGANIZATION AND ACTIVITIES 

The Health Department is one of the five departments of the Panama 
Canal organization functioning directly under the Governor. It is 
charged with sanitation and the control and prevention of transmissible 
diseases in the Canal Zone and in Panama City and Colon, the treat- 
ment and hospital care of United States Government employees and 
their dependents, and others entitled to such care, the enforcement 
of quarantine regulations, and the compilation of vital statistics for the 
Canal Zone and the cities of Panama and Colon. 

Its activities are conducted under the four principal divisions indi- 
cated in the organization chart on the following page. 

The administrative functions and activities of the various divisions 
were described briefly in the annual report for 1930. 

PERSONNEL 

The principal change in personnel assigned to key positions in the 
Health Department organization during the year was the assignment 
of Col. O. G. Brown, Medical Corps, U.S. Army, as Superintendent, 
Gorgas Hospital, vice Col. A. M. Whaley, Medical Corps, U.S. Army, 
relieved on account of termination of tour of duty with The Panama 
Canal. 



tc 














uJ 




bJ 




u 




O 








•7 fc 




u. 


















</) — « 




T.T. 








Uh 




w» = 




_i 




< fe- 




«*: 




^ UJ 




UJ 




T. 




X 




u 











So 

>< 

H 














-IZ 




UI 

Z 
<H 
OZ 

<o < 




I 




1 



I— U4 

Z z 

a: ^ <_. 

% ;z z <s 

i H <5 5 

u q; o < - 

Z <<°.~ 

o U. 5«a 

«? /-\ ^ * m 
N Q 5^2 

5 -r- ? n w 

< |_ ■*■ UJ 

o n u < Q 
O < \-a> 



ul 




Z 
ui 














o 








l.£ 


o 




z 


























B£ ul 




"*Ij 






b. 

o 






zH 
►-> 

UK 




_lul 




it 
^8 


o 
























<i 












a 




2U 




£ o 


a 




_[ 















s* 




o 


52 




is 






<u 








E 




E 


1 




1 



m 



h 

si 




1 




2. 

«>3 


















" D 




1 




Ua 



3H 



21 



Sg 





"3- 




-=r- 




3 


















































£ 








£5 




ofc 




M 
ul 






ri 








O 

z: 

8 
o 

ee 
O 




O 

Z 

o 

_J 

o 




8« 
R2 




23 




< 

Z 
ul 

a. 
«o 

a 


o 

d} 



< 


a 
s 

9 







2 

o 

Q 




v 




v 




u 






















I 




1 




1 




1 













The total personnel in the service of the Health Department on 
December 31, 1932, by units, as compared with the strength for pre- 
ceding four years, is shown in the following table: 

FORCE REPORT, HEALTH DEPARTMENT, FOR DECEMBER, EACH YEAR 





1928 


1929 




1930 




1931 


1932 




2 
C 


> 


"5 
o 




1 


"3 


2 

o 

a 


H3 


"3 
o 
H 


"c 





O 

E- 


2 
~3 
O 


QQ 


E* 


Chief Health Office 


5 
166 
24 

21 

'i 

12 
10 
S 
5 


259 
38 

126 
9 

37 
25 

125 
85 

124 


5 

425 
62 

147 
23 
3S 
37 

135 
93 

129 


7 

176 

25 

19 

18 

2 
10 
11 

9 

5 


299 
52 
144 

9 
36 
23 

12S 
88 

112 


7 

475 
77 

163 
27 
38 
33 

139 
97 

117 


7 

167 

29 

22 

16 

1 

11 
11 

9 

6 


267 
54 

141 
15 
28 
20 

118 
87 

117 


7 

434 
83 

163 
31 
29 
31 

129 
96 

123 


7 
169 


243 


7 

412 
87 

159 
32 
29 
32 

129 
97 

126 


6 
162 
32 
21 

J l 
12 
11 
8 
6 


252 
55 

139 
17 
28 
19 

105 
95 

141 


6 
414 




32 55 
21 138 


87 




160 




17 
1 

12 
11 

8 
6 


15 

28 
20 

118 
89 

120 


33 


Palo Seco Leper Colony ■ . 

Quarantine service 

Health Office, Panama. . . . 
Health Office, Colon 


29 
31 
116 
103 
147 








Total 


266 


828 


1,094 


282 


891 


1,173 


279 


847JI.126 


284 


8261,110 


275 


8511.126 









Note. — "Gold" are white American employees, with the exception of two white aliens and one colored alien. 

"Silver" are alien employees, principally West Indians (colored). 
1 Includes inmates paid for services rendered. 

The distribution of the gold personnel, on the basis of professional 
or other qualifications, was as follows: 



33 physicians, medical officers of 
the U.S. Army 
1 physician, surgeon of the U. S. 
Public Health Service 
29 physicians, civilian 

1 dentist, U.S. Army 
9 internes 

9 male nurses 
101 female nurses 

2 district nurses 
35 clerks 

11 sanitary inspectors 

1 sanitary assistant 

2 quarantine inspectors 
4 veterinarians 

8 technicians 



7 dispensary assistants 
5 pharmacists and assistant phar- 
macists 
2 chemists 
2 general mechanics 

2 stewardesses 

3 dietists 

1 storekeeper 

1 dental hygienist 

1 vaccinator 

1 carpenter foreman 

1 chauffeur foreman 

1 physio-therapy aide 

1 electrician 

1 embalmer 



The increase in force is an apparent rather than a real one. There 
was a reduction of nine in the gold force. The increase in the silver force 
was due to readjustment of working hours, principally in street cleaning 
and garbage collection and disposal gangs in Panama City and Colon, 
to relieve unemployment. Heretofore a considerable number of em- 
ployees worked on a 7-day week basis; this was reduced to a 6-day 
week, wages adjusted accordingly, and additional men employed to 
cover the activities without additional expense. 



FINANCIAL STATEMENTS 

Operating Expenses and Earnings of the Health Department, 
Calendar Year 1932 



Operating expenses 



Earnings 



Gorgas Hospital 

Colon Hospital 

Corozal Hospital (for the insane, chronics and 

cripples) 

Palo Seco Leper Colony 

Maritime Quarantine Service 

Sanitation of Panama City and Colon 

Street cleaning and garbage collection and dis- 
posal, Panama City and Colon 

Canal Zone sanitation 

Line dispensaries 

Medical storehouse 

Chief Health Office and miscellaneous 



$753,460.10 
2 167,132.29 

3 185,612.69 

36,899.94 

570,911.71 

67,337.03 

138,516.02 

141,140.04 

' 96,510.09 

6,957.16 

^37,741.91 



$352,808.75 
85,359.59 

173,362.00 

23,891.25 

17,186.31 

9,503.26 

113,622.79 
49,635.03 
41,055.20 



1,463.17 



Total. 



1,702,218.98 



867,887.35 



1 Includes Army pay of Army medical officers on duty in this institution which amounted to S11S.908.74 

Also includes cost of operation of Board of Health Laboratory. 

' Includes Army pay of Army medical officers on duty in this institution which amounted to 24,637.90 

Also includes cost of operating Colon Dispensary. 

' Includes Army pay of Army medical officers on duty in this institution which amounted to 14,697.96 

^Includes Army pay of Chief Health Officer which amounted to 7, 200 . 00 

Total Army pay of Army medical officers on duty in Health Department 165,444.60 

s Includes Public Health Service pay of Public Health Officer acting as Chief Quarantine Officer, which 

amounted to 5,232.10 



Includes Army and Public Health Service pay, which amounted to - 170,676.70 

Operating Expenses of the Health Department, Calendar Year 1932, 
Showing Amounts Charged to Various Accounts 



Gold pay roll (white employees): 

Panama Canal pay $612,378.80 

Army pay 165,444.60 

Public Health Service pay 5,232.10 $783,055.50 

Silver pay roll (colored employees) 428 , 307 . 64 

Subsistence supplies 188,212.50 

Tee 4,921.20 

Hospital supplies and drugs 70,864. 21 

Equipment 10,280.83 

Miscellaneous material and supplies 61, 753 . 59 

Laundry 31,049.85 

Telephones 14,585.84 

Repatriation of patients physically or mentally disabled 2,128.56 

Medical storehouse operation 6,957.16 

Launch service 5, 13 1.51 

Mechanical Division repairs, oxygen, etc 3,205.91 

Electric current 15,310.55 

Electric repair* and installations 1, 668 . 33 



Water $12,449.56 

Freight 2,489.06 

Motor transportation charges (except for hospitals, quarantine 
station, and dispensaries which operate their own motor vehi- 
cles) 49,326.96 

Repairs to motor vehicles of hospitals, dispensaries and quarantine 

station 1,777.49 

Rentals of quarters 1,210.48 

Miscellaneous charges 7, 532 . 25 

Total expenses 1,702,218.98 

The funds for the operation of the Health Department consist 
of direct appropriations from Congress and earnings from various 
sources. The extent to which the Health Department has been self- 
supporting during the calendar years 1923 to 1932, inclusive, is shown 
in the following table: 





Gross operating 
expenses 


Earnings 


Percent 
self-supporting 


1923 


$1,415,944.19 
1,476,385.27 
1,430,484.91 
1,542,473.15 
1,628,376.14 
1,821,696.73 
1,902,222.27 
1,910,689.69 
1,827,845.00 
1,702,218.98 


$685,596.02 
703,137.81 
721,005.34 
755,843.70 
860,926.35 
937,469.38 
1,022,940.76 
995,733.57 
894,809.11 
867,887.35 


48 


1924 


48 


1925 


50 


1926 


49 


1927 


53 


1928 


51 


1929 


54 


1930 : 


52 


1931 


49 


1932 


51 







The extent to which the various units of the Health Department 
were self-supporting during the years 1923-1932 is indicated in the 
following table: 



Percent self-supporting 
(Army pay included) 

Calendar years— 



1923 



1924 



1925 



1926 



1927 



192S 



1929 



1930 



1931 



1932 



Gorgas Hospital 

Colon Hospital 

Corozal Hospital 

Palo Seco Leper Colony 

Line dispensaries 

Quarantine Division 

Sanitation, Panama and Colon 

Street cleaning and garbage collection and 

removal, Panama City and Colon 

Zone sanitation 

Health Department as a whole 



The average cost per patient per day for hospital care and treatment 
in the various Panama Canal hospitals during the calendar years 1928 
to 1932 has been as is indicated in the following table. These costs 
include operations, maintenance, and full salaries (that is, including 



10 



the Army pay of Army medical officers assigned to the various hos- 
pitals), and the cost of operating the Board of Health Laboratory. 
Capital charge for construction, interest on physical plant values, and 
amortization charges are not included : 





Calendar years 




1928 


1929 


1930 


1931 


1932 


Gorgas Hospital: 

(a) Including cost of Ancon Dispensary until September 1929; 

also including cost of Board of Health Laboratory 

(b) Including cost of Ancon Dispensary until September 1929, 

but excluding cost of the Board of Health Laboratory 


4.66 
4.44 


■ 5. OS 

4.87 


5.40 
5.16 


5.07 
4.83 


5.03 
4.76 






Colon Hospital: 


6.43 
6.96 


5. IS 
5.55 


■ 4.27 
4.55 


4.39 
4.65 


4.72 


(6) Including cost of Colon Dispensary; also including the cost 
of the work done for this hospital by the Board of Health 


5 04 






Corozal Hospital: 

(a) Including cost of operation of dairy until December 1930; 

also including cost of operating gardens and cemetery. . . 

(6) Same as above, also including cost of the work done for this 


1.00 
1.03 


.90 
.92 


.88 
.90 


70 

.72 


.65 
.67 








1.39 
1.40 


1.25 

1.26 


1.06 
1.07 


1.35 

1 36 


.96 


(6) Including cost of the work done for this institution by the 


.97 







Gross operating expenses for the Health Department as a whole for 
1932 were about $125,500 less than for the previous year and $208,500 
less than for 1930, the peak year. Earnings for 1932 ($867,887) were 
$27,000 less than for 1931 and $155,000 less than for 1929 when they 
attained the highest point of record ($1,022,940). The brunt of the 
reduction in earnings has fallen on Gorgas Hospital. The earnings of 
that unit reached a peak of $486,000 in 1929, since which time they 
have gradually been declining. In 1932 they were $352,808— $133,000 
less than in 1929. 

Notwithstanding the marked decline in gross operating expenses 
and earnings during the past three years the number of patient days 
spent in Panama Canal hospitals has gradually been increasing and 
in 1932 reached the highest peak attained (508,776) since completion 
of the Canal. 

Two general classes of patients are cared for in Panama Canal hos- 
pitals, namely: Those suffering from acute ailments in which the 
turnover is rapid and large (Gorgas and Colon hospitals) and those re- 
quiring domiciliary care, most of whom remain in hospital until death 
(Corozal hospital for the Insane and Palo Seco Leper Colony). 

The number of patient days spent in Gorgas and Colon hospitals 
(acute cases) in 1932 was 21,000 less than in 1931, whereas patient 



11 



days in Corozal Asylum and Palo Seco Leper Colony were 30,425 more 
than for 1931. Reductions in patient days and admissions to Gorgas 
and Colon hospitals is attributable in part to reduction in force of 
about 2,000 employees in 1932 (1931, total force, 14,597; 1932, 12,621). 
Lepers and insane chargeable to the Republic of Panama are cared for 
at the expense of the Government of .Panama, the charge per patient 
per day being 75 cents which about covers cost of operation and 
maintenance and does not include interest and amortization charges 
on capital investment in buildings, etc. (approximately $700,000). 
Practically all other patients in Corozal Hospital and Palo Seco Leper 
Colony are cared for at the expense of the Health Department. 

Data on patient days in hospitals and numbers of admissions to 
hospitals for the past five years are included in the following table: 

NUMBER OF PATIENT DAYS IN HOSPITALS AND ASYLUMS 

1932 



Gorgas Hospital 

Corozal Hospital: 

Insane patients 

Cripples and chronic medical and sur- 
gical cases 

Colon Hospital 

Palo Seco Leper Colony 

Total : 



1928 


1929 


1930 


1931 


184,945 


184,506 


163,975 


165,050 


200,735 


209,794 


228,862 


228,327 


25,459 
21,342 
38,001 


27,623 
30,755 
36,568 


28,923 
41,158 
36,102 


29,883 
41,508 
34,947 


470,482 


489,246 


449,020 


499,715 



149,812 

253,240 

31,802 
35,379 
38,543 

508,776 



VITAL STATISTICS— POPULATIONS OF THE CANAL ZONE, 
PANAMA CITY, AND COLON 

The Health Department of the Panama Canal secures, analyzes, and 
makes reports on the vital statistics (births, deaths, and disease rates) 
of three geographical units of the population residing on the Isthmus 
of Panama, namely, the population of the Canal Zone, of the city of 
Panama, and of the city of Colon. 

Properly to interpret these statistics, it is essential that there be some 
understanding of the composition of the various units of the popula- 
tion, their movement, and some of the special local factors involved 
which usually are not encountered in stabilized populations in many 
parts of the world. These special factors were discussed somewhat in 
detail in the annual report of the Health Department for 1930 (pages 
12 to 15, inclusive) which can be obtained on request to the Chief 
Health Officer, Balboa Heights, Canal Zone. 

The Republic of Panama takes a census every 10 years, the last 
enumeration having been made in 1930. In Panama City, from 1920 
to 1930, the population made an average increase per year of almost 
exactly 1,500, and that figure has been used as the factor in computing 
the population each year since 1920 by arithmetical progression. For 
1932 the population is estimated to be 77,500 (arithmetical progression). 



12 



In Colon, from 1920 to 1930, the census figures indicate an average 
decrease of 150 per year, and that figure has been used as the factor 
in computing the population between 1920 and 1930 by arithmetical 
progression. As there is some doubt as to the accuracy of the 1930 
census of Colon, 30,000 was adopted for 1931, and continued for 1932. 

The population of the Canal Zone consists of white American em- 
ployees and their families, colored alien employees and their families, 
military and naval garrisons, representatives of shipping companies, 
contractors, church and welfare workers, etc., and colored alien agri- 
culturists who rent land under revocable licenses. A census of the 
Canal Zone population is taken each year and all figures for this group 
are actual rather than estimated. 

The term "employees" as used in Health Department reports in- 
cludes employees of the Panama Canal proper and the Panama Rail- 
road Company, which is a corporation owned by the United States 
Government. 



GENERAL DEATH RATES, ALL CAUSES, AND FROM 
DISEASE ONLY 

Death rates from all causes for all groups of the population are avail- 
able since the beginning of construction (1905) and those from disease 
only are readily available since 1913. These data are incorporated 
and shown graphically in tables appearing in the annual report for 1931. 
In this report the data presented will be limited almost entirely to a 
presentation and discussion of the death rates for 1932 and a tabulation 
of death rates by consecutive 5-year periods to show trend. Those 
interested in the rates for previous years are referred to the annual 
report for 1931. 

Population, Canal Zone.— The death rate from all causes during the 
year 1932 in the Canal Zone population was 7.30 per 1,000 of population 
(pop., 42,070; deaths, 307). Deaths from disease only were 272 in a 
population of 42,070 or a rate of 6.47 per 1,000. The general death 
rate (7.30) was the lowest of record (1905-1932) except for the year 
1930 (7.14). The death rate for disease only (6.47) was about 6 percent 
higher than for 1931 (6.09) which was the lowest of record. 

During the past five years the trend in death rates, both general and 
for disease only, has been a downward one as is evidenced by the 
following comparison of rates by 5-year periods since 1913: 

CANAL ZONE DEATH RATES BY 5- YEAR PERIODS 





1913-17 


1918-22 


1923-27 


1928-32 




13.91 
11.90 


8.10 
6.82 


8.28 
7.19 


7.62 




6.55 







13 



The population in the Canal Zone is only now becoming a somewhat 
stabilized one. The new factor now beginning to influence the vital 
statistics in this population is the advancing age of the employees with 
a greater prevalence of diseases of the chronic degenerative type, par- 
ticularly in the colored population. 

It may be anticipated that death rates for a few years will have a 
tendency to increase pending complete stabilization of the population. 

Panama City. — Death rates from all causes (1905-1931) and those 
for disease only (1913-1931) are incorporated in statistical tables and 
presented graphically in the annual report for 1931 (pages 13 and 14). 

The general death rate for 1932 was 15.90 per 1,000 of population 
(pop., 77,500; deaths, 1,232) the lowest of record. The nearest approach 
to this low 'rate was attained in 1923—17.28 per 1,000 (pop., 64,000; 
deaths, 1,106). The death rate for disease only was also the lowest of 
record, 15.11 per 1,000 of population (pop., 77, 500; deaths, 1,171). The 
trend of these rates is shown in the following analysis of rates by 5-year 
periods : 

PANAMA CITY DEATH RATES BY 5-YEAR PERIODS 





1913-17 


1918-22 


1923-27 


1928-32 




30.56 
29 32 


21.06 
20.35 


17.55 
16.97 


18.06 




17.34 







Increase in rates for the last 5-year period over those for the imme- 
diately preceding one resulted from excessively high rates for the years 
1928 and 1929, 20.06 and 19.36, respectively, for all deaths and for 
deaths from disease 19.44 and 18.37. Rates for the three remaining 
years of the period were: All deaths, 1930, 17.57; 1931, 17.64; 1932, 
15.90; deaths from disease only, 1930, 16.81; 1931, 16.76; 1932, 15.11. 
For purposes of comparison it may be said that the general death rate 
for Manila, P. I., was 25.61 in 1931, for New Orleans, it was 17.7 in 
1929, for Atlanta, Ga., it was 15.7 in 1929, and for New York City it 
was 11.3 in 1929. 

Colon. — In 1932 the death rate from all causes in Colon was 
14.43 per 1,000 of population (deaths, 433; pop., 30,000) and for disease 
only 13.50per l,000of population (deaths, 405 ; pop., 30,000). The death 
rate from all causes is the lowest of record save for the years 1922, 1923, 
1925, and 1927 (14.40, 12.78, 13.17, and 14.03) and that for disease 
only is the lowest of record except for the years 1923, 1925, and 
1927 (12.26, 12.45, and 13.40). 



14 



Death rates from all causes and from disease only by 5-year periods 
have been as follows: 



COLON DEATH RATES BY 5-YEAR PERIODS 





1913-17 


1918-22 


1923-27 


1928-32 




25.08 
23.85 


18.48 
17.40 


14.08 
13.41 


15 82 


Death rates from disease per 1,000 population 


15.01 



It is evident that the general trend since 1913 has been a downward 
one though the rates for the last 5-year period (1928-1932) are some- 
what higher than for the 5-year period of 1923-1927. 

BIRTH RATES, CANAL ZONE, PANAMA CITY, AND COLON 

In analyzing birth rates it is important for many reasons to have 
knowledge not only of the total rate for the new born, but to know also 
the rate of those born alive and of the stillborn. The data necessary 
for such tabulation are available since 1916 and were incorporated in 
the annual report for 1931. 

BIRTHS, CANAL ZONE POPULATION (EMPLOYEES AND 

NON EMPLOYEES) 

In 1932 the total number of births in the Canal Zone was 492 in 
a population of 42,070, or a rate of 11.69 per 1,000 of population. The 
birth rate in the population in the Canal Zone has been decreasing every 
year since 1924 when it was 21.65 per 1,000 of population. In 1932 the 
rate per 1,000 of population for babies born alive was 11.38 (number, 
479; pop., 42,070) and for the stillborn, 0.31 (number, 13; pop., 42,070). 
The rate for the stillborn was much the lowest of record, only about 
one-third of that usually experienced. 

The striking decrease in birth rates in the Canal Zone since 1916 can 
best be appreciated by comparing the average rates by 5-year periods: 

CANAL ZONE BIRTH RATES BY 5- YEAR PERIODS 



1918-22 



1923-27 



1928-32 



Total birth rate per 1,000 population 
Live birth rate per 1,000 population. 
Stillbirth rate per 1,000 population. . 



23 69 

22.54 

1.15 



18.73 

17.76 

.97 



13.23 

12.49 

.74 



The marked decrease in birth rates during recent years is attribut- 
able in large measure to the following factors: Advancing age of the 
employees who entered service during the construction period; and a 
large proportion of generation born in Canal Zone has not yet attained 
maturity and married. 



15 



That the increase in maternity welfare activities during recent years 
is bearing fruit is evidenced by the gradual decline in the rates for the 
stillborn. 

The population of the Canal Zone is made up of two quite different 
elements, (a) white American employees and their families, Army and 
Navy officers and their families, Army and Navy enlisted personnel, 
and (b) colored alien employees and agriculturists and their families. 
The large number of unmarried enlisted personnel of the Army and 
Navy (approximately 10,600 during 1932) results in an abnormally low 
birth rate among the white population. 

Since 1921 birth rates have gradually declined in both groups of the 
Canal Zone population (see annual report, 1931, for details). Compar- 
ing birth rates in 1932 with those of 1921 there has been a decline of 
60 percent for white Americans and 54 percent for the colored popu- 
lation. The rate of decline in both groups can best be appreciated by 
comparing average rates by 5-year periods: 

CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS 





1918-22 


1923-27 


1928-32 




White 


Colored 


White 


Colored 


White 


Colored 


Total birth rate per 1,000 population 


16.91 

16.37 

.54 


30.41 

2S.65 
1.76 


13.36 
12.89 

.47 


23.42 

22.01 

1.41 


9.71 

9.39 

.32 


16.04 
14.96 


Stillbirth rate per 1,000 population 


1.08 



The average rates for the last 5-year period show a decline of 43 per- 
cent for white and 47 percent for colored births compared with the 
period 1918-1922. It may be anticipated that birth rates, particu- 
larly those for the colored group of the population, will begin to increase 
in the near future unless a considerable proportion of the younger 
generation now beginning to attain maturity seek employment else- 
where than in the Canal Zone. 

Panama City. — The birth rates per 1,000 of population for Panama 
City for 1932 were: Total births, 32.32; live births, 31.01; stillbirths, 
1.31 (pop., 77,500; total births, 2,505; born alive, 2,403; stillborn, 
102). 

The total rates for Panama City have been fairly stationary for the 
past 12 years, with a slight tendency to decrease for the period as a 
whole (see annual report, 1931). Increasingly larger numbers of pros- 
pective mothers are now admitted to hospital for confinement, and it 
is estimated that at the present time, of all births in Panama City, about 
50 percent are born in Santo Tomas Hospital. The midwives, during 
recent years, have been more closely supervised, and during the past 



16 



three years their work has been under the constant supervision of a 
visiting nurse with special training in midwifery. During 1932 a visit- 
ing nurse service was established in Panama City, a supervising nurse 
having been brought down from the United States to inaugurate this 
service and to train the groups of Panamanian nurses selected for this 
duty. That these measures are beginning to show results is evidenced 
by the downward trend in the stillbirth rates which has been contin- 
uous for the past two years. The rate for stillborn during 1932 was 
the lowest of record. The trend of total birth rates, live birth rates, 
and stillbirth rates is shown in the following averages of rates by 
5 -year periods for the past 15 years: 

PANAMA CITY BIRTH RATES BY 5- YEAR PERIODS 



1918-22 



1923-27 



1928-32 



Total birth rate per 1,000 population 
Live birth rate per 1,000 population. 
Stillbirth rate per 1,000 population. . 



38.72 

36.41 

2.31 



34.03 

32.24 

1.79 



34.60 

32.99 

1.61 



Colon. — The birth rates for the city of Colon for 1932 were: Total 
births, 30.77; live births, 29.33; stillbirths, 1.43 (pop., 30,000; total 
births, 923; born alive, 880; stillborn, 43). 

The general trend in birth rates for Colon during the past five years 
has been to increase. Considering the rates by 5-year periods for the 
past 15 years, the average for each period is as follows: 

COLON BIRTH RATES BY 5- YEAR PERIODS 



Total birth rate per 1,000 population 
Live birth rate per 1,000 population. 
Stillbirth rate per 1,000 population. . 



1918-22 



31.78 

29.89 

1.89 



1923-27 



25.12 

23.76 

1.36 



1928-32 



29.55 

28.13 

1.42 



INFANT MORTALITY RATES, CANAL ZONE, PANAMA CITY, 

AND COLON 



The infant mortality rates per 1,000 of live births for the three 
groups of population concerned, Canal Zone, Panama City, and Colon, 
for 1932 were as follows: 

Canal Zone: 

Live births (absolute numbers) — 

American (white), 147; alien (colored), 332; total, 479. 
Deaths of children under 1 year of age (absolute numbers) — 

American (white), 3; alien (colored), 31; total, 34. 
Rate per 1,000— 

American (white), 20; alien (colored), 93; total, 71. 



17 



Panama City: 

Live births (absolute numbers), 2,403. 

Deaths of children under 1 year of age (absolute numbers), 311. 

Rate per 1,000, 129 
Colon : 

Live births (absolute numbers), 880. 

Deaths of children under 1 year of age (absolute numbers), 61. 

Rate per 1,000, 69. 

The better to visualize any results being obtained in the reduction 
of infant mortality rates in the three groups of the population con- 
cerned, the average rates for each group by 5 -year periods are tabu- 
lated below : 

INFANT MORTALITY RATES FOR 5- YEAR PERIODS, CANAL ZONE AND CITIES OF 
PANAMA AND COLON 





Period 


Canal Zone 


Panama 


Colon 




White 


Colored 


Total 


1918-22 


33.04 
44.02 
48.48 


131.73 
111.87 
106.25 


96.08 

88.87 
86.97 


162.28 
131.68 
136.32 


153 81 


1923-27 


116 95 


1928-32 


100 97 







Canal Zone. — Infant mortality rates in the white American popula- 
tion of the Canal Zone have been quite satisfactory, ranging between 
18 and 59 per 1,000 live births for the years 1917 to 1932, inclusive, 
except for 1928 when the rate was 94. For the colored population the 
variation during the same period has been between 88 and 180 (see 
annual report, 1931). The rates in the colored group were consider- 
ably in excess of 100 (107 to 143) during the years 1926 to 1929, 
inclusive, and since then have been consistently below 100 (93 to 96). 
Efforts are being made to lower these rates through a visiting nurse 
service. As a result of the low rate in the white American population 
(20) the general infant mortality rate for the Canal Zone for 1932 was 
unchanged from the record low rate of 71 set in 1931. 

Panama City. — Considerable progress has been made since 1917 in 
reducing infant mortality rates in Panama City. The rates for the 
5-year period 1918-1922 averaged 162.28 per 1,000 live births, whereas 
for the 5-year periods 1923-1927 and 1928-1932 they had been reduced 
to 131.68 and 136.32, respectively. 

Colon. — Excellent progress has been made in reducing the infant 
mortality rates in Colon. For the 5-year period 1918-1922 the rate 
averaged 154, whereas for the period 1928-1932 it had declined to 101. 

MR 35955—2 



18 



PRINCIPAL CAUSES OF DEATH, CANAL ZONE, 
PANAMA CITY, AND COLON 

It has been customary in the Health Department annual reports of 
recent years to report the six principal causes of death from disease in 
Panama Canal employees and in the populations of the cities of 
Panama and Colon. Commencing with the 1930 report, comparable 
data for the entire population of the Canal Zone have been included. 
The statistics for the past five years for the three population groups 
involved, Canal Zone, Panama City, and Colon, are being included in 
this report. 

Principal causes of death, Canal Zone population. — The data on this 
subject are incorporated in the following table : 

SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, CANAL ZONE POPULATION, 1928-1932 
(absolute numbers and rates per 1,000) 



Population. 



Disease 



Tuberculosis (various organs) . . . 
Organic diseases of the heart. . . . 

Cancer (various organs) 

Apoplexy 

Pneumonia (broncho and lobar). 

Syphilis. 

Nephritis (acute and chronic) . . . 
Diseases of the arteries 



1928 



37,056 



Num- 
ber 



Rate 
per 
1,000 



.674 
.297 
.432 



.972 
.297 
.513 



1929 



38,825 



Num- 
ber 



Rate 
per 
1,000 



.876 
.386 
.412 



.695 
.283 
.592 



Num- 
ber 



Rate 
per 
1,000 



.507 
.557 
.405 



.785 
.253 
.532 



1931 



40,565 



Num- 
ber 



Rate 
per 
1,000 



.468 



.370 



.567 
.271 
.444 
.271 



1932 



42,070 



Num- 
ber 



Rate 
per 
1,000 



.784 
.475 
.428 
.333 
.333 
.238 
.238 



Tuberculosis and pneumonia have usually taken the greatest toll of 
life in the population of the Canal Zone; in 1932 tuberculosis was again 
in first place, but pneumonia dropped to fifth place, being replaced by 
organic diseases of the heart. Diseases of the chronic degenerative type 
are being noted with greater frequency as principal causes of death. 
It is of special interest to note that deaths from apoplexy and diseases 
of the arterial system have occurred with such great frequency during 
the past two years as to have become one of the six most frequent 
causes of death (diseases of the arteries in 1931 and apoplexy in 1932). 
Tuberculosis and the pneumonias affect the colored population to a 
far greater extent than the white. 

Principal causes of death, Panama City. — The six principal causes of 
death in the population of Panama City for the past five years are 
shown in the following table : 



19 



SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, PANAMA CITY, 1928-1932 
(absolute numbers and rates per 1,000) 



Population . 



Disease 



Tuberculosis (various organs) 

Pneumonia (broncho and lobar) 

Diarrhea and enteritis, including colitis. 

Cancer (various organs) 

Nephritis (acute and chronic) 

Organic diseases of the heart 

Syphilis 



1928 



71,500 



Num- 
ber 

227 
248 
117 



115 

105 

48 



Rate 
per 
1,000 

3.17 
3.47 
1.64 



1.61 

1.47 

.67 



1929 



73,000 



Num- 
ber 



204 
231 
148 
67 
114 
118 



Rate 
per 
1,000 



2.79 
3.16 
2.03 
.92 
1.56 
1.62 



1930 



74,402 



Num- 
ber 



208 
180 



59 
113 



Rate 
per 
1,000 



2.42 
1.32 
.79 
1.52 
1.32 



1931 



76,000 



Num- 
ber 



218 
202 
135 
62 
64 
137 



Rate 
per 
1,000 



2.87 
2.66 
1.78 
.82 
.84 
1.80 



1932 



Num- 
ber 



203 
174 
104 



Rate 
per 
1,000 

2.62 

2.25 

1.34 

.89 

.89 
.86 



Tuberculosis and the pneumonias continue to be the leading causes 
of death. Death rates from these two diseases are much higher in 
Panama City than in the population of the Canal Zone. The death 
rates from tuberculosis in the Canal Zone ranged between 0.51 and 0.88 
per 1,000 population for the years 1928-1932, whereas comparable 
rates in Panama City ranged between 2.62 and 3.17. The differences in 
rates are attributable in large measure to housing conditions in Panama 
City and the economic status of the populations affected. 

A similar disparity will be noted between death rates from the pneu- 
monias in Panama City and the Canal Zone. The very high rates in 
Panama City as compared with the Canal Zone are attributable to the 
factors cited in the case of deaths from tuberculosis. 

Principal causes of death, Colon. — The six principal causes of death 
in the population of Colon, for the years 1928 to 1932, are shown in the 
following table: 

SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 1928-1932 
(absolute numbers and rates per 1,000) 



Population . 



Disease 



Tuberculosis (various organs) 

Pneumonia (broncho and lobar) 

Nephritis (acute and chronic) 

Organic diseases of the heart 

Apoplexy 

Diarrhea and enteritis, including colitis. 

Syphilis 

Cancer (various organs) 



Num- 
ber 



Rate 
per 
1,000 

2.10 
2.27 

.77 



29.S50 



Num- 
ber 

64 
03 
30 
28 
28 
31 



Rate 
per 
1,000 



2.14 
2.11 
1.01 
.94 
.94 
1.04 



1930 



29,765 



Num- 
ber 



Rate 
per 
1,000 



2.39 
1.65 
1.38 
1.08 



1.14 
.87 



1931 



30,000 



Num- 
ber 



Rate 
per 
1,000 



3.00 

1.70 

.80 

1.07 

.77 
.87 



1932 



30,000 



Num- 
ber 



Rate 
per 
1,000 



2.47 
1.53 
1.10 
1.00 
.90 
.60 



It will be noted, as was the case in the other groups of the population 
of the Isthmus, that the leading causes of death are tuberculosis and 
the pneumonias. 

The most interesting point to be noted is that the death rates from 
both tuberculosis and the pneumonias are very materially lower in 
Colon than in Panama City, the higher rate for tuberculosis in Colon 
in 1931 being an exception. The average rates per 1,000 population 
per annum for two 5-year periods from 1923 to 1932 are as follows: 



20 



AVERAGE DEATH RATES PER 1,000 POPULATION PER ANNUM, FOR 5- YEAR PERIODS, 1923-1927, 
AND 1928-1932, FROM PNEUMONIAS AND TUBERCULOSIS 



Pneumonias, 1923-1927. 
Pneumonias, 1928-1932. 



Tuberculosis, 1923-1927. 
Tuberculosis, 1928-1932. 



Panama 


Colon 


2.89 

2.78 


1.42 

1.85 


2.96 

2.85 


2.38 
2.42 



The factors responsible for this difference are not known with cer- 
tainty. On the average, housing conditions in Colon are better than 
in Panama City. The rates for Panama City are artificially high due 
to the fact that the principal Panamanian Government hospital 
(Santo Tomas) is located in Panama City and patients treated in that 
hospital who actually reside in the provincial districts not infrequently 
give a Panama City address as their place of residence. Efforts are 
made to eliminate this factor of error, but so far they have not been 
completely successful. 

ACUTE TRANSMISSIBLE DISEASES REPORTED IN 1932 
Beginning with the annual report of 1929, a table was introduced 
showing the number of cases of transmissible diseases reported to the 
Health Department of the Panama Canal. The reports for the Canal 
Zone are quite complete, but for Panama City and Colon they are not, 
especially for the less serious diseases such as whooping cough, mumps, 
etc. The cases reported during 1932 are incorporated in the following 
table : 

CONTAGIOUS AND INFECTIOUS DISEASES— CASES AND DEATH REPORTED TO THE 
CHIEF HEALTH OFFICER DURING THE YEAR 1932 











Reported place of infection 








Disease 


Panama 


Colon Canal Zone 


Outside the 

Zone and Total 
terminal cities j 




New 
cases 


Deaths 


New 
cases 


Deaths cases 


Deaths 


New 
cases 


Deaths 


New 
cases 


Deaths 




124 

48 
11 

3 

72 
113 


4 
2 

1 
2 
9 


29 
12 
2 

1 
23 
173 

1 


1 
1 


47 
23 
3 

6 
719 

88 


1 
2 

1 
1 

1 


20 
18 
11 

3 
431 

16 


1 

4 

1 

31 

2 


220 
101 

27 

13 

1,245 

390 

1 
11 
(■) 
7 
3 
11 







6 


Dysentery, amebic. . . 

Dysentery, bacillary 

(unclassified) 


9 

3 
35 




12 


Meningitis, meningo- 






2 

(') 
1 
1 






8 


14 
2 


1 

(') 


39 






174 


(') 
4 


46 


2 


273 




2 




2 
1 










3 




7 


1 


1 










Tuberculosis 


(') 
2 


203 
1 


C) 
3 


74 


(') 
4 


33 
1 


(') 
9 


39 
4 


C) 
18 


349 
6 


Whooping cough 
Maritime Quarantin- 
able diseases 


12 


3 


13 




39 




7 




71 


3 




7 


3 




1 




2 


7 


1 


14 


7 


















































Typhus fever 


'3 
















'3 





■ As many cases of pneumonia and tuberculosis are not reported until death occurs, this report shows only the 
number of deaths from these two diseases. 

2 Sporadic cases which in some respects resembled clinically mild typhus as it occurs in the United States (Brill's 
disease), giving positive Weil-Felix reaction. 



21 

This table gives one a definite conception of the type of transmissible 
diseases that are most commonly encountered in this region. In 
general terms the data show the following facts so far as the populations 
of the Canal Zone, Panama City, and Colon are concerned. 

The so-called intestinal group of diseases (typhoid and para-typhoid 
fevers and the dysenteries) are of rare occurrence. The fatality rate 
in diphtheria is very low. While measles is of not uncommon occur- 
rence it is but seldom complicated by pneumonias and the fatality rate is 
low. Scarlet fever and meningococcus meningitis but rarely occur and 
usually a considerable proportion of the few cases of meningitis en- 
countered are confined to military personnel, the disease having been 
contracted in the United States (recruits en route to foreign service). 
In cities so closely surrounded by a large rural population heavily in- 
fected with malaria the difficulties in deciding as to the place of infec- 
tion with malaria parasites are obvious. Evidence collected indicates 
that the cases of. dysentery reported from Panama and Colon are con- 
tracted in the provincial districts of the Republic. Pneumonia and 
tuberculosis are very common, with high fatality rates. 

VITAL STATISTICS, PANAMA CANAL EMPLOYEES 

Statistics covering this particular group of the population are quite 
complete. Force reports showing total number of employees are con- 
stantly available, and when time is lost on account of illness, record is 
made of that fact. Reports of diagnosis of cases in quarters on account 
of convalescence after hospitalization or on account of minor complaints, 
ordinarily are not recorded in morbidity reports, except in the case of 
malaria. Malaria constitutes the most important cause of noneffec- 
tiveness in employees and all clinical cases requiring treatment by a 
physician (hospital or quarters) are made the subject of a special report 
and included in the statistics on malaria, in data relating to admission 
rates to hospitals and quarters and in noneffective rates. 

In August 1930, a new policy was put into effect that should have a 
tendency to reduce the malaria rates among employees. In large 
construction projects in nonsanitated areas, much of the labor is drawn 
from nearby villages, sometimes as high as 50 percent, and a consider- 
able number of the laborers from such sources are carriers of the mala- 
rial parasite but have no clinical symptoms. Formerly, not until these 
laborers became ill, and upon being sent to the District Physician were 
found to have malaria, did they receive treatment for it. The new 
policy consists of making routine monthly malaria blood surveys of 
laborers engaged on such projects, and administering quinine reguarly 
to those found to be positive, irrespective of the fact that no clinical 



22 

symptoms were noted. It can be assumed that a certain proportion 
(just what proportion we do not venture to estimate) of the individuals 
so treated would, if not treated, come down with subjective or ob- 
jective symptoms of malaria at one time or another. The individuals 
found positive for malaria in this group, practically all of whom are 
residents of native villages and employed temporarily by the Panama 
Canal, are not included in the Health Department malaria statistics 
unless they become ill and lose time from their work on account of 
malaria. 

It should also be pointed out that statistics relating to employees are 
not representative of a homogeneous geographical group of the popu- 
lation. The American white employees of the Canal reside in the Canal 
Zone under hygienic and environmental conditions that are quite 
satisfactory. The Panama Canal, however, employs approximately 
9,200 colored alien individuals only about one-third of whom live in 
the permanent towns of the Canal Zone, the remainder, with their 
families, living in Panama City, Colon, and elsewhere, under much less 
favorable hygienic conditions. 

In the interpretation of statistics relating to employees, it is there- 
fore necessary to give consideration to the factors outlined above, as 
well as to those mentioned in the introductory paragraphs on vital 
statistics in this report. 

EMPLOYEES, GENERAL DEATH RATES, ALL CAUSES 

The general death rate for employees for 1932 was 8.95 per 1,000 
employees (number employed, 12,621; deaths, 113) the lowest since 
1926. 

Since 1921, the general tendency has been for death rates for employ- 
ees to increase, the rates for 1931 and 1932 having been exceptions. 
The rates during the early construction period were high (1906-1910, 
18.63). After completion of the Canal when the population became 
stabilized and the employees were still comparatively young, the death 
rates attained their lowest ebb (1921-1925, 7.23). 

During recent years the average age of this group has gradually 
increased, a larger proportion of individuals are becoming disabled with 
and dying as the result of diseases of the so-called chronic degenerative 
type, and the general death rates are gradually increasing (1928-32, 
9.24). 

EMPLOYEES, DEATH RATES, DISEASE ONLY 

Death rates from disease only for all Panama Canal employees and 
the racial distribution of these rates (white and colored) are incorpor- 
ated in the following table: 



23 



EMPLOYEES, DEATHS FROM DISEASE ONLY 

ABSOLUTE NUMBERS AND RATES PER 1,000, WHITE, COLORED, AND TOTAL 











Nu 


mber of deaths 


Death- rate Der 1.000. 


Year 


Number of employees 


from disease only 




disease only 






White 


Colored 


Total 


White 


Colored 


Total 


White 


Colored 


Total 


1906. . . 


5,106 


21,441 


26,547 


'19 


1,024 


1,043 


3.72 


47.76 


39.29 


1907... 


10,604 


28,034 


39,238 


97 


848 


945 


9.15 


29.62 


24.08 


1908. . 


12,383 


31,507 


43,890 


90 


291 


381 


7.27 


9.24 


8.68 


1909. . 


11,662 


.35,505 


47,167 


75 


281 


356 


6.43 


7.91 


7.55 


1910.. 


13,021 


37,781 


50,802 


64 


317 


381 


4.92 


8.39 


7.50 


1911 .. 


12,251 


36,625 


48,876 


72 


302. 


374 


5.88 


8.25 


7.65 


1912... 


12,553 


38,340 


50,893 


58 


266 


324 


4.62 


6.94 


6.37 


1913 .. 


11,943 


44,711 


56,654 


43 


254 


297 


3.60 


5.68 


5.24 


1914... 


7,024 


37,305 


44,329 


47 


265 


312 


6.69 


7.10 


7.04 


1915 . 


4,719 


30,066 


34,785 


15 


126 


141 


3.18 


4.19 


4.05 


1916 ... 


4,552 


28,624 


33,176 


15 


137 


152 


3.29 


4.79 


4.58 


1917... 


4,814 


27,775 


32,589 


22 


165 


187 


4.57 


5.94 


5.74 


1918 ... 


4,408 


21,112 


25,520 


16 


166 


182 


3.63 


7.86 


7.13 


1919 . 


4,523 


19,681 


24,204 


8 


142 


150 


1.77 


7.21 


6.20 


1920. . . . 


4,688 


15.9S5 


20,673 


17 


136 


153 


3.63 


8.51 


Y.40 


1921 ... 


3,855 


10,534 


14,389 


10 


72 


82 


2.59 


6.83 


5.70 


1922 .. 


2,827 


. 7,620 


10,447 


10 


54 


64 


3.54 


7.09 


6.13 


1923 ... 


2,846 


8,130 


10,976 


15 


52 


67 


5.27 


6.40 


6.10 


1924 ... 


3,055 


8,570 


11,625 


13 


51 


64 


4.26 


5.95 


5 51 


1925... 


3,123 


9,057 


12,180 


9 


S5 


94 


2.88 


9.39 


7.72 


1926... 


3,121 


9,611 


12,732 


18 


77 


95 


5.77 


8.01 


7.46 


1927.... 


3,197 


10,364 


13,561 


19 


87 


106 


5.94 


8.39 


7.82 


1928... 


3,308 


10,952 


14,260 


19 


112 


131 


5.74 


10.23 


9.19 


1929... 


3,505 


12,688 


16,193 


23 


128 


151 


6.56 


10.09 


9.33 


1930... 


3,589 


11,935 


15,524 


27 


148 


175 


7.52 


12.40 


11.27 


1931... 


3,551 


11,046 


14,597 


21 


96 


117 


5.91 


8.60 


8.02 


1932... 


3,387 


9,234 


12,621 


15 


87 


102 


4.43 


9.42 


8.08 



■ Americans only. 

The death rate for white employees in 1932 (4.43) was the lowest 
since 1925. For colored employees, it was well below the average of 
the latest 5-year period, but higher than the 1931 rate. 

The above table discloses an interesting point. During the 27-year 
period, death rates for white employees were lower than for colored 
without an exception, and markedly so in many instances. This 
difference is further emphasized by comparing the average annual 
rates by race, by 5-year periods: 



Year 



1918-1922 1923-1927 



1928-1932 



White employees. . . 
Colored employees. 



4 30 

5.62 



3.00 
7.61 



4.82 
7.70 



6.06 
10.22 



The average death rate for colored employees for the last 5-year 
period was 69 percent higher than for white employees. The compara- 
tively low rates in white employees are attributable to many factors 
favorable to such employees, among which may be mentioned : Rates 
of pay, scale of living, physical stamina, intelligence, education, hygiene 
and sanitation in the home and immediate environment, and return 
to the United States after becoming disabled. Another important 
factor is that while in both racial groups the average age has gradually 
increased to such an extent that diseases of the so-called chronic 
degenerative type are becoming more common, they are affecting the 



24 



colored employees proportionately to a greater degree than white em- 
ployees, and increasingly larger numbers of colored employees are 
dying of such diseases while still in active service. 

It is to be noted that in recent years death rates in both groups of 
employees are attaining higher levels, although the 1931 and 1932 rates 
are notable exceptions. The diseases which caused the greatest mor- 
tality in 1932 were: Tuberculosis, 17; organic diseases of the heart and 
arteriosclerosis, 9 each; syphilis, pneumonia, and nephritis, 8 each. 
Tuberculosis, arteriosclerosis, organic diseases of heart and disease of 
coronary arteries caused more deaths in 1932 than in 1931, whereas 
syphilis, pneumonia, nephritis, and cancer proved less fatal, especially 
pneumonia. 

ADMISSIONS TO HOSPITALS AND QUARTER9 

The admission rate to hospitals and quarters was 725 per 1,000 
employees. This rate has been increasing each year since 1926 (1926, 
474; 1932, 725) and is attributable to gradual increase in the age of 
those employed (greater prevalence of diseases of the chronic degenera- 
tive type). 

The admission rate per 1,000 to hospitals for disease by race (white 
and colored) has been as follows for the past five years: 

ADMISSION RATE PER 1,000 EMPLOYEES, BY RACE (WHITE AND COLORED) 





White 


Colored 


1928 


240 
273 
288 
310 
310 


128 


1929 


154 


1930 


180 


1931 


187 


1932 


171 



PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES TO HOSPITALS 

The six diseases causing the greatest number of admissions of em- 
ployees to hospitals during the past five years are incorporated in the 
following table: 

EMPLOYEES, PRINCIPAL CAUSES OF ADMISSION TO HOSPITALS 





1928 


1929 


1930 


1931 


1932 


Diseases 


Total 


Rate 
per 
1,000 


Total 


Rate 
per 
1,000 


Total 


Rate 
per 
1,000 


Total 


Rate 
per 
1,000 


Total 


Rate 
per 

1,000 


Malaria (including the few cases treated 
in quarters) 


203 


14 


337 


21 


410 


26 


276 


19 


177 
124 
97 
81 
79 
77 


14 
10 




121 
103 


8 
7 


184 
113 


11 

7 


136 


9 


153 
131 


10 
9 


8 




6 








6 








109 
153 
121 


7 
9 
7 


106 


7 






6 




49 
94 
70 


4 
7 
5 


270 
106 
114 


19 

7 
8 






130 
150 
113 


8 

10 
7 









































25 



NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES 

The noneffective rate for 1932 was 17.06 per 1,000 employees. This 
rate is gradually increasing, the rate for the 5 -year period, 1923-1927, 
having been 13.39 per 1,000 employees, as compared with a rate of 15.46 
for the 5-year period, 1928-1932. 

ADMISSION RATES, MALARIA, HOSPITAL AND QUARTERS, EMPLOYEES 

Malaria is the most important disease prevention problem in which 
the Health Department is engaged. Every effort is made to diagnose 
and report in morbidity statistics all clinical cases seen by Panama 
Canal physicians. Statistical records of cases of malaria occurring in 
employees are the most accurate and complete that are compiled for 
any special group of the population residing in the Canal Zone, except 
military personnel, as employees absent from duty must secure a cer- 
tificate from a physician to cover absence on account of illness in 
order to be paid for time lost. 

The admission rates per 1,000 per annum for all employees for the 
years 1906 to 1932, inclusive, are incorporated in the following table: 

Malaria Cases, Employees Only 
Absolute numbers and rates per 1,000 employees 





Average 


Number 


Rate 






Year 


number 


of 


per 








employed 


cases 


1,000 






1906 


26,547 
39,238 
43,890 


21,795 
16,637 
12,372 


821 
424 
282 




1907 
1908 






1909 


47,167 


10,169 


215 


HBE9H 




1910 


50,802 


9,487 


187 


■BHHHBI 




1911 


48,876 


8,987 


184 


■BBHIH 




1912 


50 , 893 


5,623 


110 


■"" 




1913 


56,654 


4,284 


76 






1914 


44,329 


3,635 


82 






1915 


34,785 


1,781 


51 






1916 


33,176 


547 


16 


1 




1917 


32,589 


473 


14 


1 




1918 


25,520 


472 


18 


1 




1919 


24 , 204 


752 


31 






1920 


20,673 


401 


19 


1 




1921 


14,389 


214 


15 


1 




1922 


10,447 


176 


17 


1 




1923 


10,976 


212 


19 


1 




1924 


11,625 


190 


16 


1 




1925 


12,180 


330 


27 


■ 




1926 


12,732 


179 


14 


1 




1927 


13,561 


145 


11 


1 




1928 


14,260 


203 


14 


1 




1929 


16,193 


337 


21 


■ 




1930 


15,524 


410 


26 


■ 




1931 


14,597 


276 


19 


■ 




1932 


12,621 


177 


14 I 





26 

In the annual report for 1931 the local situation with respect to 
malaria, the influence on its occurrence of large construction projects 
in nonsanitated areas, and the control measures instituted in construc- 
tion camps, were discussed somewhat in detail. 

The malaria rate in employees, when normal conditions obtain and 
when no large construction projects beyond the so-called permanently 
sanitated areas are under way, varies from about 14 to 19 cases per 
1,000 employees per annum, dependent on the character of the malaria 
season. Occasionally it happens that during the season of rains natural 
conditions are such that great curtailment in the breeding of mosqui- 
toes occurs with a consequent enormous reduction in density of the 
mosquito population. When nature interposes these barriers the 
malaria rates are abnormally low as was the case in 1927, when it was 
only 11 per 1,000. y In 1930 the situation was apparently reversed and 
the rates rose to W, though more than half of the increase was attribut- 
able to the occurrence of malaria in employees engaged in large con- 
struction projects outside the protected areas. 

In 1932 the rate was only 14, this notwithstanding that large labor 
gangs were engaged in road building (Thatcher Highway) and- con- 
struction activities (Madden Dam) outside the protected areas and 
that with the opening of highways into the interior of the Republic of 
Panama, increasingly larger numbers of American employees and their 
families were exposing themselves to and contracting malaria through 
week-end and other visits to resorts in the provincial districts of 
Panama. 

There is but little doubt that had conditions in 1932 been the same 
as in 1927 (lack of highways into the interior of Panama and no large 
construction projects beyond the sanitated areas) the rate would have 
been as low as and probably less than in 1927 (11 per 1,000) which is 
the lowest of record. The probable correctness of this statement is 
supported by the following data : 

Excluding from consideration the cases of malaria occurring in em- 
ployees engaged in field projects outside the permanently protected 
areas the rates for the following years were as follows: 1925, 16.5; 1926, 
14.1 ; 1927, 10.7; 1928, 13.7; 1929, 13.7; 1930, 18.5; 1931, 16.1; 1932, 13.0. 

In 1932 the malaria rate in white employees was 20 per 1,000 and in 
1931 only 18. Comparable rates in colored employees were: 1932, 12; 
1931, 19. The increase in rates in white employees in 1932 over 1931 
was undoubtedly due to exposure to infection in nonsanitated areas, 
most of which was unnecessary and against which employees had been 
warned. Our records show that in 1932, 69 white American employees 
had attacks of malaria. Of this number, the history of the movements 



27 

of the individual prior to the appearance of clinical symptoms indicates 
that 56 contracted the disease through exposure to infection outside 
protected areas. In 1931 and 1932 a number of employees built more 
or less substantial houses in a village on a beach about 60 miles from 
Balboa (Pacific coast) with a view to using them during vacations and 
for week-end visits. The Health Department was not consulted as to 
health conditions in that particular locality. It is known to be a par- 
ticularly undesirable location from the viewpoint of malaria. One 
malaria blood survey of a representative sample of the native popula- 
tion of the village (New Gorgona) made in the fall of 1932, showed an 
infection rate of 56 percent (number examined, 76; number positive for 
malaria, 43). Our malaria records for 1932 show that 14 white Ameri- 
can employees and 13 members of their families (total 27) contracted 
the disease at this one place (New Gorgona Beach). 

Incidentally it is worthy of note that one employee who contracted 
the disease at New Gorgona during the Christmas holidays in 1932 
died of malaria in January 1933 (treatment not sought until in a coma- 
tose condition). 

Analyses of malaria rates in this area and investigations of the sources 
of infection, extending over a period of many years, emphasize that one 
must be most conservative in attributing seasonal reductions or in- 
creases in rates to one factor or another. Many factors must be given 
consideration, some of which are known and others unknown, and it is 
difficult to evaluate the importance of each. Extended observations 
indicate that the breeding habits of the malaria transmitting mos- 
quitoes, variations in amounts and spacing of rainfall, and changes in 
local flora, influence greatly the density of the mosquito population and 
that these factors vary greatly from year to year. It also has become 
evident that dispersal flights of malaria transmitting Anopheles as well 
as other species of mosquitoes, at the beginning and end of the season 
of rains, extend over wider areas and for greater distances than were 
thought to be the case some years ago. All these factors are being 
studied continuously. 

DEATH RATES, MALARIA, EMPLOYEES 

The death rates from malaria, Panama Canal employees, 1906 to 
1931, were tabulated and shown graphically in the annual report for 
1931. No deaths of employees from malaria occurred in 1932. 

DIVISION OF HOSPITALS, DISPENSARIES, AND CHARITIES 

The units comprising this division and the scope of the activities 
undertaken by them were described in the annual reports for 1930 and 



28 

1931. There was no change in the number or activities of such units 
during 1932. Brief reports of "certain of these units follow: 

GORGAS HOSPITAL 

(Normal capacity, 880 beds) 
Col. Orville G. Brown, Medical Corps, U.S. Army, Superintendent 

During the year, there was no new building construction. The 
routine work of maintenance and repair of buildings and equipment was 
performed by hospital artisans. 

Cases treated. — There were 11,330 admissions during the year, with a 
total of 149,812 patient days, making an average of 13.22 days spent 
in hospital per patient. The average number of beds occupied daily 
during the year was 409.05. 

Surgical service. — There were 1,996 major operations (with 29 deaths) 
and 4,201 minor operations (with 4 deaths) performed during the year; 
482 obstetrical cases were delivered, in which there were 10 twin births 
and 19 stillbirths; 9,544 patients received treatment in the out-patient 
clinic. 

Medical service. — During the year, 5,381 patients were treated in the 
medical wards. In addition to the hospital service, 8,300 patients were 
treated in the out-patient clinic. 

Eye, ear, nose and throat services. — There were 10,933 visits to the 
out-patient department; 2,122 operations were performed and 1,543 
refractions were done. 

Radiographic service. — There were 6,672 cases, for which 16,360 films 
of various sizes were used, and in which 894 fluoroscopic examinations 
were made. 

Dental service. — There were 5,622 sittings during the year; 1,595 oral 
examinations and surveys, 2,364 teeth extracted; 318 complete and 
918 partial X-ray examinations. 

Physio-therapy service. — Treatments were given to 1,604 out-patients 
and 1,087 hospital in-patients, during the year. 

BOARD OF HEALTH LABORATORY 

(Operated in connection with Gorgas Hospital) 

Dr. L. B. Bates, Chief of Laboratory 

Bacillus typhosus. — Recovered in blood culture from 11 individuals 
and from stool specimens of 1 other; 4 of these lived in Colon City, 3 
were transients, 2 lived at Madden Dam, 1 in Panama City, and 1 in 
La Boca. In addition, B. typhosus were recovered repeatedly from stool 



29 

specimens of a 22-month old colored infant who ran a typical course of 
typhoid fever. This child lived on leased land in the Canal Zone away 
from main settlements. 

Typhoid carriers. — On December 31, 1931, there was only one B. 
typhosus carrier, H. B., under sanitary surveillance. His stool speci- 
mens were examined nine times during the year and found positive three 
times. No new carriers were found during the year. 

Typhus fever. — G. T., Gorgas Hospital number 338407, age 33, white, 
female, lifetime resident of Panama, ran a fairly definite course of ty- 
phus fever in the hospital. On the tenth day of the disease her blood 
serum, in a dilution of 1-320, agglutinated B. proteus X 19 . Four days 
later her blood serum, in a dilution of 1-640, completely agglutinated 
a culture of X 19 . 

C. de la O., Panama Hospital number 24572, age 12, white, female, 
lifetime resident of Panama, also diagnosed typhus fever, gave a three 
plus positive Weil-Felix reaction in a dilution of 1-160 and a one plus 
reaction in a dilution of 1-320 and 1—640. 

M. H., Panama Hospital number 24575, age 50, white, female, life- 
time resident of Panama, diagnosed typhus fever, gave a positive Weil- 
Felix reaction first in a dilution of 1-20 and seven days later in a dilution 
of 1-160. 

Reports. — Approximately 40,500 reports not including duplicates 
have been made. 

BACTERIOLOGICAL PROTOZOAL AND MISCELLANEOUS EXAMINATIONS 

Total 

Blood cultures 247 

Positive for B. typhosus (Eberthella typhi) 10 

Positive for B. paratyphosus B {Salmonella schottmulleri) 1 

Positive for Staphylococcus aureus 10 

Positive for Streptococcus viridans 3 

Positive for Pneumococcus (Diplococcus pneumoniae) 1 

Positive for B. coli (Genus Escherichia) 1 

Stools cultured for typhoid-dysentery group 1 ,017 

Positive for B. typhosus (Eberthella typhi) on patients 23 

Positive for B. typhosus (Eberthella typhi) on carriers 3 

Positive for B. dyscnteriae, Group II (Shigella paradysenteriae) 13 

Urines cultured for typhoid group 626 

Positive for B. typhosus (Eberthella typhi) 3 

Positive for B. paratyphosus B (Salmonella schottmulleri) 1 

Urines cultured for organisms other than typhoid group 593 

Positive for B. coli (Genus Escherichia) 160 

Positive for B. coli and gram positive cocci 1 

Positive for Staphylococcus albus 12 

Positive for Staphylococcus aureus 4 

Positive for Streptococcus (hemolytic) 1 

Positive for Streptococcus anhaemolyticus 1 

Positive for B. pyocyaneus ( Pseudomonas aeruginosa) 2 

Throat cultures for B. diphtheriae (Corynebacterium diphtheriae) 1 , 140 

Positive for B. diphtheriae (Corynebacterium diphtheriae) 90 

Nasal cultures for H. diphtheriae (Corynebacterium diphtheriae) 561 

Positive for B. diphtheriae (Corynebacterium diphtheriae) 43 

Throat cultures for organisms other than B. diphtheriae (Corynebacterium diphtheriae) 52 

Positive for Slaphyloccus aureus 1 

Positive for Streptococcus viridans 2 

Positive for Streptococcus (hemolytic) 4 

Eye cultures 19 

Positive for Staphylococcus albus 1 

Positive for Staphylococcus aureus 3 

Positive for B. coli (Genus Escherichia) 1 



30 

Total 

Ear cultures 4 

Sputum cultures 33 

Positive for Streptococcus viridans 2 

Positive for Pneumococcus Type IV ( Diplococcus pneumoniae. Type IV) 1 

Spinal fluid cultures 122 

Positive for Pneumococcus (Diplococcus pneumoniae) 4 

Positive for Pneumococcus Type I (Diplococcus pneumoniae Type I) 2 

Positive for Pneumococcus Type III (Diplococcus pneumoniae Type III) 1 

Surgical tissues cultured 2 

Pleural fluid cultures 38 

Positive for B. tuberculosis (Mycobacterium tuberculosis) 1 

Knee fluid cultures 24 

Gland cultures T. 2 

Cultures from skin lesions 16 

Positive for Staphylococcus aureus 5 

Cultures of pus from various sources 23 

Positive for Staphylococcus aureus 2 

Autopsies cultured 43 

Organs, exudates, etc ' 38 

Bile cultures 1 

Darkfield examinations 63 

Positive for Treponema pallidum 2 

Darkfield examinations for yaws 5 

Conjunctival smears 61 

Positive for Gram negative intracellular diplococci 10 

Ear smears 1 

Cervical gland smears 3 

Throat smears .• .- 59 

Positive for fusiform bacilli and spirilla of Vincent's angina (Borrelia vincenti and Fusiformis 

dentium) 10 

Smears from venereal lesions 1 

Positive for spirilla similar to those found in Vincent's angina 1 

Rectal smear 1 

Positive for Gram negative intracellular diplococci 1 

Urethral smears 35 

Positive for Gram negative intracellular diplococci 4 

Vaginal and cervical smears 13 

Vaginal smears 56 

Positive for Gram negative intracellular diplococci 12 

Sputum smears for B. tuberculosis (Mycobacterium tuberculosis) 48 

Positive for B. tuberculosis (Mycobacterium tuberculosis) 13 

Urine for B. tuberculosis (Mycobacterium tuberculosis) 10 

Spinal fluid for B. tuberculosis (Mycobacterium tuberculosis) 78 

Positive for B. tuberculosis (Mycobacterium tuberculosis) 2 

Cell count of spinal fluids 2 

Examination of leper suspects 18 

Positive for B. leprae (Mycobacterium leprae) 9 

Pure nerve type, negative for B. leprae (Mycobacterium leprae) 2 

Clinically leprosy 1 

Examination of lepers previous to parole ; 1 

Examination of paroled lepers 4 

Positive for B. leprae (Mycobacterium leprae) 2 

Autogenous vaccines prepared 43 

Feces examined for parasites and ova 118 

Positive for Entamoeba histolytica 3 

Positive for ova of Taenia nana 1 

Positive for ova of Trichuris trichiura : 5 

Positive for ova of Ascaris lumbricoides 1 

Positive for ova of Ascaris lumbricoides and Trichuris trichiura 1 

Positive for ova of Uncinaria, Ascaris and Trichuris trichiura .- 1 

Blood platelet counts , 7 

Differential counts 3 

Red blood counts 1 

White blood counts 2 

Hemoglobin estimations 

Blood films examined fof malarial parasites 411 

Positive for Tertian malarial parasites 159 

Positive for E. A. malarial parasites 154 

Positive for Quartan malarial parasites 5 

Positive for Tertian and Quartan malarial parasites combined 1 

Water 1 , 121 

Ice examined for bacterial count and B. coli 52 

Washing powder "Swift's Pride" 1 

Foodstuffs examined: 

Army emergency rations 9 

Cream cultured for bacterial count 5 

Ice cream cultured for bacterial count 90 

Milk cultured for bacterial count (dairy) , 649 

Sausage cultured for food poisoning organisms 1 

Soda water cultured for B. coli and bacterial count 198 



31 



SEROLOGICAL EXAMINATIONS 

Total 

Wassermann tests 18 , 827 

Kahn tests 1 ,519 

Agglutination tests 246 

Positive with B. typhosus (Eberthella typhi) 4 

Positive with B. paratyphosus A (Salmonella schottmulleri) 1 

Positive with B. proteus Xis (Proteus vulgaris) 6 

Fragility tests • • 14 

Blood typing for transfusion 53 

Examination of blood for coagulation time 4 

Examination of blood for bleeding time 1 

Analysis of Wassermann reactions. — 17,979 Wassermann tests were 
performed on the blood of 13,569 persons. The results are summarized 
below : 

TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT 
BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1932 



Race, sex, and status 


Individuals 
positive 


Individuals 
negative 


Total 

individuals . 

tested 


Percent of 

individuals 

positive 


White, civil: 


83 

27 

2 


1,885 

511 

37 


1,968 

538 

39 


4 2 




5.0 




5.1 






Total 


112 


2,433 


2,545 


4 4 






White, military and naval: 


165 
21 


3,769 
208 


3,934 
229 


4 2 




9 2 






Total 


186 


3,977 


4,163 


4 5 






Black and mulattoes: 


537 

333 

12 


2,955 

2,743 

204 


3,492 

3,076 

216 


15 4 




10 8 


Children 


5 6 






Total 


882 


5,902 


6,784 


13 








8 


69 


77 


10 4 








1,188 


12,381 


13,569 


8 8 







In addition, Wassermann tests were made on 848 spinal fluids taken 
from 562 individuals. The results are summarized below: 

Individuals positive 71 

Individuals negative 491 

Total individuals tested 562 

Percent of individuals positive 12 . 63 



32 



THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH 
LABORATORY, 1904 to 1932 





8 






cS 


-D J> 










■s 














e3 


8 3 


DEI 








O) 




M-2 




o 




















































3 






33 


2-a 


-a 




■£ 


S 


T3§ 




_3 2 


Year 


1i 


5 

'3 
o 

s 

3 
CD 

c 


o 

3 
3 


.£tj 
xi a 

H 


o. a 

O >i 


a 

o 

.3 


c c 

°_C 03 


ci 

"a 
bO 


-c 
'o 
c 


H t 
§13 
t C 

ceo 


a 


.1 °- 

to"2 

!§ 




z 


Ch 


fri 


w 


< 


O 


O 


C 


H 


Q 


O 


CO 


1904 


6 

269 


1 

60 


1 
9 




















1905 


27 


3 


8 


5 


3 


9 




2 




1906 


509 


191 


22 


50 


24 


23 


39 


15 


33 




2 




1907 


496 


156 


35 


27 


40 


27 


36 


12 


58 


4 


4 


1 


1908 


361 


59 


63 


46 


26 


25 


23 


11 


14 




7 


2 


1909 


295 


55 


37 


26 


32 


31 


11 


17 


11 


1 


5 




1910 


451 


50 


91 


52 


30 


37 


30 


16 


10 


6 


4 


1 


1911 


508 


83 


102 


41 


38 


36 


19 


20 


9 


11 


11 




1912 


425 


53 


79 


23 


37 


27 


15 


22 


6 


7 


11 


2 


1913 


460 


47 


89 


21 


34 


26 


8 


26 


5 


23 


12 


11 


1914 


375 


36 


78 


6 


38 


12 


6 


27 


5 


14 


3 





1915 


328 


28 


56 


14 


20 


12 


5 


14 


9 


15 


10 


9 


1916 


323 


25 


81 


8 


17 


20 


7 


10 


6 


9 


7 


15 


1917 


330 


24 


51 


5 


21 


23 


3 


18 


1 


3 


5 


12 


1918 


253 


38 


68 


6 


6 


12 




8 




1 


5 


5 


1919 


324 


22 


55 


3 


15 


14 


3 


20 


3 


10 


11 


8 


1920 


. 334 
289 


'46 
14 


55 

37 


4 


29 
16 


11 
5 


5 

8 


16 
17 






6 

7 


15 


1921 


2 


4 


20 


1922 


262 


14 


29 


5 


19 


9 


4 


9 


3 


6 


10 


14 


1923 


205 


6 


17 


3 


9 


9 


5 


12 


2 


1 


11 


14 


1924 


263 


14 


33 


3 


29 


10 


4 


21 


1 


3 


13 


12 


1925 


306 


15 


34 


7 


38 


11 


3 


IS 


1 


3 


16 


17 


1926 


282 


14 


32 


5 


32 


9 


2 


11 




5 


13 


25 


1927 


358 


27 


22 


10 


35 


17 


3 


19 


2 


1 


21 


23 


1928 


436 


45 


40 


8 


40 


20 


3 


13 


2 


10 


19 


46 


1929 


453 


40 


44 


6 


48 


21 


5 


10 


4 


11 


23 


37 


1930 


375 


26 


40 


2 


45 


26 


1 


23 


3 


1 


15 


48 


1931 


388 


31 


34 


11 


68 


16 


3 


20 


1 


10 


17 


41 


1932 


348 


12 


41 


4 


39 


8 


4 


29 


1 


1 


16 


28 


Total . . . 


10,012 


1,232 


1,375 


423 


828 


505 


266 


457 


194 


160 


288 


411 



1 This includes 32 cases of influenza. 

The annual report for 1930, page 54, contains a table showing the 
number of autopsies performed for the years 1904-1930 in certain 
diseases that but rarely come to autopsy in this area. The additions 
to this table for 1932 were as follows: Yellow fever, 0; beriberi, 0; 
ankylostomiasis, 0; tetanus, 1 ; infectious diseases of children, 4; plague, 
0; smallpox, 0. 

Per cent auto psied. — 575 bodies (not including 47 for storage only and 7 
disinterred) passed through the laboratory; 348, or 60.52 percent were 
autopsied. 



Malaria carriers found at autopsy. 
Syphilis found at autopsy (cases) . . 



Intestinal parasites jound at autopsy. — 13 cases in 348 autopsies per- 
formed at the laboratory, or 3.74 percent, showed one or more parasites 
or their ova, as follows: 



Ascaris 9 

Uncinaria 3 

Trichuris 2 

Trichuris trichiura 1 



Endamoeba histolytica 1 

Oxyuris vermicularis 1 

Trichocephalus 1 



33 
Multiple infections occurred as follows: 

Uncinaria and trichocephalus 1 

Ascaris, Trichuris and Uncinaria 1 

Ascaris, Trichuris tricbiura and Oxyuris vermicularis 1 

WILD AND DOMESTIC ANIMALS 

Bacteriological: 

Blood smear from horse (negative for B. anthracis) 1 

Lung culture from calf 1 

Spleen culture from horse (negative for B. anthracis) 1 

Spleen cultures from guinea pigs 35 

Spleen cultures from rabbits 37 

Agglutination tests 6 

(Serum of 6 cattle with B. abortus, 3 weakly positive 1-40) 

Total 81 

Autopsies: 

Guinea pigs 33 

Rabbits 36 

Total 69 

Histological examinations: 

Autopsy tissues from cows 32 

Positive for B. tuberculosis 32 

Total 32 

Rats examined: 

Mus musculus 1 ,541 

Mus alexandrinus 59 

Mus nnrwegicas 108 

Mus rattus 1 ,489 

Total 3,197 

MICROSCOPIC SLIDES PREPARED 

Surgical tissue preparations (51 frozen) 2,998 

Autopsy tissue preparations (3 frozen) ' 6,373 

Animal tissue preparations 141 

Total 9,512 

PHOTOGRAPHS 

J.W.F., Gorgas Hospital No. 345230— pellagra 1 

LP., Gorgas Hospital No. 343446— lupus erythematosus disseminatus 4 

Total 5 

CHEMICAL ANALYSES AND EXAMINATIONS 

Alcohol analyses 1 

Ascitic fluid — bile pigments 1 

Beverages 11 

Beer 1 

Rum 1 

Soda water (positive for salicylic acid) 2 

Vov 1 

Whisky 2 

Wine 4 

Bloods 2,241 

Nonprotein nitrogen determinations 1 , 895 

Urea nitrogen determinations .• 336 

Uric acid determinations 123 

Creatinin determinations 553 

Glucose determinations 2 ,085 

Calcium determinations 14 

Carotin determinations 1 

Creatine determinations 2 

Carbon dioxide determinations 6 

Cholesterol determinations 3 

Sodium chloride determinations 14 

Phosphorus determinations 1 

Icterus index 112 

Van den Bergh reaction 13 

Albumin-globulin ratio 1 

Proteins, serum 4 

Lactic acid in equine blood 19 

MR 35955 3 



34 

Calibrations — sphygmomanometer 5 

Calibrations — pipettes 37 

Calibrations — flasks, volumetric 5 

Cube root, rotenone determination 2 

Drugs and chemicals 11 

Carbolic acid, crude 4 

Cattle dip, arsenical 3 

Larvicide 1 

Opium extract 1 

Soap dye 1 

Xylol 1 

Foodstuffs 716 

Butter _ 4 

Cream, fat determination 5 

Ice creams 78 

Lard compound 1 

Margarine for mineral oil 1 

Milks, dairy 618 

Determination of acidity 3 

Milks, evaporated 3 

Milks, mother's 2 

Sugar cane juice 1 

Sugar cane syrup 1 

Gastric analyses 488 

Ores, iron determination 2 

Seazone, free chlorine 1 

Sea water, detection in rugs 1 

Soda solution, washing 82 

Spinal fluids 880 

Colloidal gold 836 

Globulin tests. 836 

Glucose determinations 61 

Stains on shirt 1 

Substances for identification 15 

Cocaine 12 

Cocaine and adrenaline 1 

Opium 1 

Powder, cleaning 1 

Toxicological 6 

Bones (dog food) (negative for poisons) 1 

Brain (negative for alcohol) 1 

Stomach contents (negative for alcohol) 1 

Stomach contents and urine (positive for cresol) 1 

Stomach contents and urine (urine positive for veronal) 1 

Stomach (negative for alkaloids and heavy metals) 1 

Urine 339 

Albumin 1 

Blood , 1 

Blood and bile pigments 1 

Fat (negative) 1 

Glucose 47 

Hemoglobin 3 

Lactose 1 

Lead determinations (92 positive) 102 

Mercury, negative 1 

Phenol, negative 2 

Sugar identification 1 

Routine analyses : 168 

Vomitus (negative for poisons) 2 

Water, sediment 2 

Water for chlorides 6 

Water for phenol detection ..'.... 2 

Acetone, recovered liters. . 8 

Alcohol, butyl, recovered liters. . 30 

Alcohol, ethyl, recovered liters. . 212 

Benzol, recovered liters . . 32 

Creosote, recovered liters. . 0.5 

Chaulmoogra esters prepared liters. . 28 5 

Dakins solution prepared liters. . 479 

UNDERTAKING DEPARTMENT 

Bodies received (including 7 disinterred and 47 for storage) 575 

Bodies embalmed 100 

Bodies cremated 116 

Bodies buried on Isthmus 378 

Bodies shipped from Isthmus (including 7 disinterred) 77 



35 

COLON HOSPITAL 

(Capacity, 120 beds) 
Maj. Dean F. Winn, Medical Corps, U.S. Army, Superintendent 

This hospital has continued to function essentially as an emergency 
hospital although definitive treatment has been given to a wide range 
of cases. Individuals requiring certain special examinations, for 
which equipment is inadequate, those with venereal and contagious 
diseases, and mental and tuberculosis cases, were transferred to Gorgas 
Hospital. 

On August 15, 1932, an eye, ear, nose and throat service was es- 
tablished. An average of 750 out-patients per month have visited 
this clinic. It has filled a definite and long-felt need for people on the 
Atlantic side of the Isthmus. There were 301 operations performed, 
classified as follows: 

Tonsillectomy and adenoidectomy, general anesthesia 123' 

Tonsillectomy, local anesthesia 106 

Nasal operations 27 

Cataracts 12 

Eye, miscellaneous 25 

Ear, miscellaneous 3 

Mastoidectomy 5 

The building for the new nurses' quarters is nearing completion. A 
new transformer layout has been installed and housed in a small con- 
crete building. This new installation obviates the dependence upon 
a single line for power and light. The hospital kitchen has been reno- 
vated throughout. Gas cooking ranges have been replaced by elec- 
tric ranges and an electric stock kettle installed. The utilities depart- 
ment has been active in preserving the appearance of buildings and 
grounds and the upkeep of the various departments. The construction 
of the new ward in the present dispensary section and the remodeling 
of the old nurses' quarters to house the dispensary was not begun as 
contemplated. This work, however, will be started early in the coming 
year and should be completed by mid-summer. Supplemental 
approved plans will provide a covered passageway between the dispen- 
sary and the main hospital, and the construction of a suite of rooms in 
the west end of the new ward for waiting rooms, examining and treat- 
ment rooms, and an operating room, for the eye, ear, nose and throat 
department. 

Movement of sick. — There were 4,130 admissions during the year, 
with a total of 35,379 patient days, an average of 8.8 days per patient. 
There were 56,406 visits to the dispensary, 360 house calls and 18 ship 
calls. Army personnel accounted for 7,744 patient days. 



36 

The average number of beds occupied daily during each month was 
as follows: 

January--!-!--- 1 98 July 81 

February 99 August 92 

March 102 September 98 

April 98 October 104 

May 99 November - 102 

June 89 December 102 

Surgical service. — There were 521 major operations and 647 minor 
operations. These afforded an interesting variety of surgical pathology 
and active emergency service. In addition this service gave definitive 
treatment to 139 fractures. 

Obstetrical service. — There were 457 deliveries during 1932. An 
active, well conducted prenatal clinic is maintained. 

Medical service. — The general scope of the work has been satisfactory 
in both volume and variety. No serious epidemics occurred during the 
year. 

X-ray department. — There were 1,257 examinations made during 
the year. New and more satisfactory equipment will be installed in 
this department during the coming year. 

Laboratory. — Only routine work is done, serological and pathological 
work being performed by the Board of Health Laboratory, Ancon, C.Z. 

Nursing staff. — It has been necessary to increase the number of 
nurses from 15 to 16 to provide for the eye, ear, nose and throat clinic. 

Dispensary. — The Colon Dispensary is an integral part of the hospi- 
tal. Its professional staff is frequently interchanged with that of the 
hospital proper. The gold clinic and maternity-pediatric clinic have 
been combined in order to conserve personnel. Daily attendance dur- 
ing 1932 averaged 155 patients. There were 22,621 white patients 
and 33,785 colored patients. These figures include out-patients visiting 
the eye, ear, nose and throat clinic. 

COROZAL HOSPITAL 

(Capacity, 835 patients) 
Maj. F. H. Dixon, Medical Corps, U.S. Army, Superintendent 

Purpose. — This institution cares for the insane of the Canal Zone 
and the Republic of Panama. It also cares for alien employees of the 
Canal Zone disabled by reason of injuries or chronic diseases who desire 
to enter the institution. 

Approximately 1,456 square feet of floor space was added to the 
workshop and storage room in the basement of the kitchen building. 



37 

Due to limited space on the female side and the rapid increase in the 
hospital census, 50 female patients were transferred on April 13, 1932, 
to building 535 (Ward "D," formerly designated as ward "C"). 

A new bungalow-type detached cottage was completed by the Con- 
structing Quartermaster in June 1932, for occupancy by a member of 
the staff of physicians. 

The sterilizer and 15-hp. boiler formerly located at the hospital dairy 
were transferred to the main steam plant and set up under one roof in 
the same shed with the 40-hp. boiler. This should prove to be very 
economical in case of breakdowns or necessary repairs. Both boilers 
are the oil burning type. 

Routine painting and repairs to woodwork, steel doors, window 
frames, plumbing, boiler, steam line, etc., have been made by hospital 
artisans, with the help of patients. 

During the latter part of December 1932, leveling and grading was 
started by the Municipal Engineering Division in connection with a 
system of roads in the new extension of the cemetery, an additional 
area of 39.37 acres. This extension will suffice to meet the needs of the 
communities on the Pacific side for many years. Considerable grading 
and road building will be required ; funds are available to cover imme- 
diate requirements and the necessary work will be completed in the 
early part of 1933. 

Insane patients. — The census on December 31, 1932, was 748, as com- 
pared with 649 at the end of the previous year. The number admitted 
was 338, as compared with 297 for 1931. There were 197 discharges 
and 42 deaths. There were no suicides or deaths due to violence 
or altercations. Of the 197 discharged, 55 were considered as cured, 
83 as improved, 59 as unimproved; 91 of the total released were 
repatriated. Six patients were transferred to Gorgas Hospital for 
treatment; 4 of these were returned to Corozal (also 2 who remained 
under treatment December 31, 1931), and 2 died. Of the total admis- 
sions, 100 were chargeable to the Government of Panama, and the re- 
mainder were Canal Zone charity cases or private pay patients. 

Other patients .—There, were on December. 31, 1932, 59 black and 5 
white chronical medical and surgical cases, not insane (in addition to 5 
out on pass), as compared with 47 black and 3 white of this class (in 
addition to 9 out on pass) at the beginning of the year. Twenty-four 
were admitted, 1 repatriated to Martinique, 1 died, and 3 were trans- 
ferred to insane status; of the 29 patients transferred to Gorgas during 
the year, only 20 were returned. All those capable of performing work 
were encouraged to do so. Twenty-five were carried on the payrolls, 



38 

employed as broom makers, bandage rollers, janitor, laborers, and 
helpers. The broom makers manufactured approximately 242 brooms 
per week. 

Recreation. — Weekly picture shows and band concerts every other 
week are forms of entertainment which continue to please the patients. 
Picnics, as in the past, were held twice a month. Church services were 
conducted once a week for the Catholic and Protestant patients. 

Treatment. — Intensive specific treatment was given to patients suffer- 
ing from syphilitic psychoses. Four hundred and ninety-six doses of 
arsphenamin were administered intravenously, and 317 lumbar punc- 
tures were made. At the end of the year there were 60 patients 
suffering from neuro-syphilis in some form; 41 of these were male and 
19 female. 

Occupational therapy.— Occupational therapy was continued in 1932 
along the lines indicated in the annual report for 1931. 

Farm. — Repairs to fences were made, and pastures cleared of brush 
during the dry season. 

There were 22 cripples employed on the farm at the close of the year, 
as compared with 24 at the beginning. During this period, 3 were ad- 
mitted, 3 quit, and 2 died in Gorgas Hospital. These men are employed 
in the garden, piggery, steam plant, cemetery, etc. Six (including one 
chronic patient) are tending plots of land in the farm reservation, which 
they cultivate as gardens and are paid on an actual production basis. 
Their average earnings per month amount to $38.92. Subsistence was 
furnished them free of charge. The receipts for produce sold aggre- 
gated $3,301.69, and for manure, $462.50. 

There were 135 pigs, 95 hogs, and 4 boars on hand December 31, 
1932. Net deficit during the year amounted to $116.50; the gross 
revenues were $1,935.29. 

Transfer of Panamanian insane. — The Panamanian Government has 
declared its intention to take over the care of the Panamanian patients 
beginning in May or June 1933. 

In the event this transfer is accomplished the remaining insane 
patients, superannuates, chronically ill and cripples can be housed in 
our permanent buildings after certain alterations in structure are made, 
and practically all of the frame buildings now housing patients can be 
demolished. 

PALO SECO LEPER COLONY 
Dr. Ezra Hurwitz, Superintendent 

During 1932, 38,543 days of treatment were furnished. There were 
99 patients in the Colony on Janaury 1, 16 new cases were admitted, 



39 

7 patients died, 1 with leprosy arrested was paroled, and 1 eloped, 
leaving 106 patients under treatment at the end of the year. Of 
these, 87 were for the account of the Republic of Panama, and 19 
were Canal Zone charity cases. 

Intramuscular administration of the iodized esters of Hydnocarpus 
wightiana was continued throughout the year in the same manner as 
during the previous several years. During October, November, and 
December, mercurochrome 220 was given intravenously in one percent 
solution to 70 patients. The average dose given was 10 cubic centi- 
meters once weekly. This treatment has been of apparent benefit in 
two cases with lepra reaction, but while improvement in general health 
has been noted in a few cases, there has been no marked change in the 
condition of leprosy in any case. 

There were two marriages. Cecilio Tejada, male Panamanian, 23 
years old, and Solidad Ruiz, female Panamanian, 18 years old, were 
married January 14; and Rafael Munoz, male Panamanian, 30 years 
old, and Elida Delgado, female Panamanian, 23 years old, were married 
October 5. Both couples were furnished with married quarters. 

There was one birth. Toribia Rivera Quesada, female Panamanian, 
30 years old, who was admitted to the Colony September 11, 1918, and 
married Jose Quesada, male Colombian, December 9, 1930, gave birth 
to a female child at the Gorgas Hospital, September 27. The child 
was cared for at the hospital, apart from its mother, until October 14, 
when the grandmother was permitted to take the child to rear. It was 
reported to be in good health January 31, 1933. 

Since August 1919, a monthly allowance in cash ranging from $1 to 
$2.50, according to the disability of the individual, has been paid to the 
patients in lieu of clothing, tobacco, toilet articles, etc. Money for 
this purpose is obtained by the sale to the patients, through the Colony 
sales storeroom, of supplies secured from the regular supplies of the 
institution. Because for several years, only subsistence supplies were 
transferred from the Asylum stock and run through the resale store, 
and also because the patients were spending less of their money for 
such supplies than they had in previous years, there was a steady dimi- 
nution in the cash made available for distribution in the monthly 
allowances. To offset this, the allowance to the patients was decreased, 
until in August a total allotment of only $100 was distributed among 
108 patients. In September, with the approval of the Chief Health 
Officer and the Auditor, we discontinued the cash allowance, and in- 
stead, established a credit system whereby each individual inmate is 
given a credit of $1.50 per month which he can use for purchasing 
necessities at the resale store. This method gives him great freedom 



40 

in manipulating his budget to suit his individual needs, and at the same 
time is an assurance that the allowance is spent for the purposes in- 
tended, and that the total allowance circulates through the resale 
store. 

The total allowances made to the patients during the year was 
$1,657.50. Twenty-three patients who cultivate small areas on the 
reservation sold a total of $557.91 worth of produce to the Commissary. 
Forty-one patients received employment in the institution during the 
year and earned $2,150.73. 

On three occasions amateur brass bands of Panama entertained the 
patients at the Colony. The 1932 carnival season was one of the 
happiest ever experienced at Palo Seco. Throughout the year weekly 
motion pictures, the radio, phonographs, and billiard and pool tables 
were a source of pleasure to the patients. 

DIVISION OF SANITATION 

The plan of organization and principal activities of this division, 
which were outlined somewhat in detail in the annual report for 1930 
(pp. 73-77) were continued without change in 1932. The usual 
routine activities (see annual report 1931, p. 50) were continued. 

SPECIAL PROJECTS UNDERTAKEN DURING 1932 

Medical care in Madden Dam area. — Construction of the Madden 
Dam, which will involve the expenditure of several millions of dollars 
and will require about four years to complete, was begun in October 
1931. The construction camps are large ones and it was necessary to 
provide a special organization to minister to the sick and injured and 
to assure the highest degree of protection practicable against malaria. 
The scope of the activities involved and the organization provided to 
carry them into effect were described in the annual report for 1931, pp. 
50-52. This organization functioned satisfactorily in 1932. Malaria 
control measures instituted gave satisfactory results. The annual 
malaria rate per 1,000 persons employed by the contractor was 46.3 
(average number employed, 625; cases of clinical malaria reported, 29). 
All factors considered, this is a very low rate. During the period of 
construction of the Panama Canal, 1907 to 1912, the annual rates 
ranged between 110 and 424 per 1,000 employees, and in 1906, the 
first year of construction, the rate was 821. 

Drainage projects. — A step was taken this year toward the drainage 
of a part of the vast coastal swamps extending 30 miles or more eastward 
from the ruins of Old Panama. The part selected was, naturally, the 
one nearest the areas already drained which lie to the west of the ruins. 



41 



A meandering river, the Matias Hernandez, flowing through the 
westernmost portion of the swamp, was completely straightened for 
about three-fourths of a mile of its course; the lower reaches of the 
river, through a half mile of dense mangrove swamp, were freed of 
fallen trees, logs, and other obstructions. The result was by no means 
all that could be desired. These swamps are but a few inches or feet 
above the high spring-tide levels and are almost absolutely flat, so 
that run-off is slow. The hoofs of dairy cattle punch the miry soil 
into countless depressions, rendering passage by human feet most diffi- 
cult and fatiguing, and furnishing myriads of small breeding places for 
Anopheles albimanus Wied. and A. neomaculipalpus Curry during the 
height of the breeding season. Even after the work on the river was 
completed it was necessary to dust, at intervals, the adjacent portion 
of the swamp with paris green from an airplane, as was described in 
the annual report for 1931. 

West of the Pacific entrance to the Canal, in the vicinity of the new 
landing for the ferry across Balboa harbor, and the recently opened 
Farfan bathing beach, tile drains and concrete sections are being in- 
stalled in the drainage ditches. 

A large hydraulic fill on the west side of the harbor, used as a dump 
for spoil pumped from the Canal in cleaning operations, will require 
unusual attention for some years to come. No permanent drainage 
system can be installed in this fill so long as it is used as a dumping 
ground, and efforts are being devoted principally to the prevention 
of mosquito breeding by the installation of shallow ditches where these 
are indicated and feasible. 

Malaria in settlers {colored aliens) living in the Canal Zone. — This 
problem was discussed somewhat in detail in the annual report for 1931 
(pp. 56-59). Depopulation has been adopted as a general policy and 
on account of economic conditions, which preclude wholesale action 
within a short period of time, this policy is being accomplished gradu- 
ally by cancellation of licenses for cause. In the fiscal year 1932 a 
total of 142 licenses were canceled. The number of licenses in force 
at the end of each fiscal year since 1923 has been as follows: 













Fiscal years — 












1923 


1924 


1925 


1926 


1927 


1928 


1929 


1930 


1931 


1932 


Agricultural 


1,805 


2,154 


2,112 


2,012 


2,019 


2,041 


2,123 


2,102 


1,927 


1,785 







Seasonal mosquito pests. — There are four species of mosquitoes com- 
mon to the Isthmus that may be classified as pests because of their 



42 

biting habits, namely: Aedes taeniorhynchus Wied., Mansonia titillans 
Walk., Culex quinquefasciatus Say, and Aedes egypti Linn. The Aedes 
taeniorhynchus is by far the worst of the lot becase of its widespread 
dispersion during the season of its activities (June to August), its long 
range dispersal flights (10 to 30 miles or more), impracticability of con- 
trolling breeding, which occurs many miles beyond the areas under 
control, and the viciousness with which it attacks human beings as well 
as animals. 

There are marked variations from year to year in breeding conditions, 
and hence in distances and density of dispersal flights. In 1931 hordes 
of this species invaded the Canal Zone, an enormous flight having 
occurred on June 9. A similar flight occurred on the night of June 10, 
1927. In 1932 no large flights occurred and the seasonal prevalence of 
this species was characteristic of a normal season. 

Mansonia titillans and, in lesser numbers, other species of this genus 
also attack man and at times become a pest, particularly in the Mira- 
flores Lake area. As the larvae develop under the surface of the water, 
securing their oxygen supply through the rootlets of aquatic plants, 
their elimination is difficult. Destruction of aquatic plants on the 
borders and headwaters of the Miraflores chain of lakes is impracticable 
because of the expense involved. During the past year or so it has 
been demonstrated that emergence of adults can be controlled mate- 
rially by extra heavy dosing with the larvicidal oil. 

Culex quinquefasciatus breeds in large numbers in the storm water 
sewers in Panama City and elsewhere during the dry season as a result 
of isolated collections of water in sections that have sunk below grade. 
This source of breeding is controlled by flushing the sewers and placing 
oil in the water at the end of the flushing thus leaving a film of oil on 
the residium of water. 

General breeding of Aedes egypti is kept at a very low index by 
routine inspections of premises and the enforcement of building regula- 
tions which forbid the installation of roof gutters. A large proportion 
of Aedes egypti breeding on the Isthmus occurs in houses occupied by 
human beings and is found in small collections of standing water within 
the house (flower vases, ant guards under the legs of tables, drip pans 
under refrigerators, etc.). 

MOSQUITOES COMMON TO THE ISTHMUS 

For many years the personnel of the Health Department have been 
studying the species and breeding habits of mosquitoes indigenous to 
this region, more particularly the anopheline group. The results of 
these investigations and improvements in control measures are pub- 



43 

lished from time to time in technical journals and the more important 
ones, from a practical point of view, are summarized in the annual 
reports of the Health Department. 

In the report for 1931 (pp. 52-54) was included a table of the species 
of anophelines known to be indigenous to this region and notes on new 
species recently observed, breeding habits of some of the more impor- 
tant species, and gradual changes in the aquatic flora in the Gatun Lake 
region which is now influencing and doubtless will in the future have 
still greater influence on the prevalence and density of certain species 
of anophelines in this region and on the incidence of malaria. 

During 1932 these studies were continued and it has become increas- 
ingly apparent that appreciable numbers of Anopheles albimanus Wied., 
the one really important vector of malaria in Panama, periodically 
invade the sanitated areas of the Canal Zone from the vast hordes of 
these mosquitoes breeding in the more remote parts of Gatun Lake. 

Naturally, the flora and fauna of this recently made lake (completed 
and filled in 1914) are undergoing constant development and change, 
the most notable feature in the floral development being the enormous 
amounts of chara now growing (mostly submerged) over vast areas of 
the shallower portions of the lake. There has been observed a definite 
relation between the amount of this plant exposed at the surface of 
the water and the surface elevation of the lake. 

The maximum permitted elevation of the lake is 87.5 feet above sea 
level, which elevation is reached in the months of November and De- 
cember to provide water for the operation of the locks and the hydro- 
electric plant during the succeeding dry season. During the four 
months of the dry season the lake gradually falls and recedes, receding 
sometimes as low as 81.4 feet above sea level before the rains again 
begin to fill it in late April or May. 

When the lake reaches its lowest level there appear at the surface 
vast carpet-like areas of matted Chara, among which are to be found 
the usual tropical microscopic vegetable and animal organisms on 
which the mosquito larvae feed. These mats also prevent ready access 
to the larvae by fish and other predators which otherwise would destroy 
them. At such times the mats of Chara shelter inconceivably great 
numbers of the larvae of A. albimanus. It is not unusual to dip up as 
many as 100 larvae of various stages of development at a single dip 
with a 4 by 8 inch bread-loaf pan. The total numbers of adult mos- 
quitoes emerging from such places over the entire lake (165 square miles 
in area) must be incalculable. 

Just before the real rainy season begins there is usually a period of 
some days or even weeks in which the weather is characteristic. High 



44 

temperatures and humidity, coupled with a cessation of the trade 
winds, hardly even a breeze stirring the air, render the days and the 
nights peculiarly oppressive. Occasional local showers may have 
already occurred, but the parched ground has absorbed the moisture 
like a dry sponge. Intensive search reveals no sign of new Anopheles 
breeding places in stream or ground pools or elsewhere; only the 
above described lake areas are teeming with larvae. 

It is at this period the flights of Anopheles albimanns appear in the 
Canal Zone towns and Army posts. Simultaneously they appear over 
the whole Isthmus. Even at Balboa Heights, as many'as a dozen or 
more may be taken in one evening by the police officer at his post at 
the entrance of the Administration Building. Colon, Cristobal, Silver 
City, and Gatun on the Atlantic side receive their visitation too. It 
would seem that not only are conditions on the lake then conducive to 
more intensive breeding, but something in the state of the weather or 
season has stimulated the mosquitoes to greater activity, and a sort 
of periodic dispersal flight is on. 

The malaria rate responds promptly to this influx of A . albimanus. 
Within a month's time, from all parts of the Isthmus increased numbers 
of cases are reported. In previous years, before the brackish tidal 
swamps on the Atlantic side of the Isthmus in the vicinity of Colon and 
Cristobal were drained, periodic invasions of those cities by hordes of 
A. tarsimaculatus Goeldi were not followed by any appreciable increase 
of the malaria incidence, even though this Anopheles could be counted 
on the outside of window screen panels by hundreds. 

It has been noted that in these lake areas A. albimanus breeding is 
markedly greater in patches of Chara in the vicinity of dwelling houses. 
In some parts of the lake, where bladderwort ( Utricularia mixta) 
occurs with the Chara, A. albitarsis Lynch Arribalzaga predominates 
markedly, occurring with A . albimanus in the proportion of more than 
three to one. At times a few A. bachmanni Petrocchi and A. strodei 
Root are taken in the bladderwort and Chara. In areas where Chara 
alone exists, only an occasional albitarsis larva is taken among hundreds 
of albimanus. Of these, only albimanus is considered to be of impor- 
tance as a malaria carrier here. 

Similar conditions in the small Miraflores Lake group near Pedro 
Miguel are controlled by oil sprays. In Stillson's pond, the small in- 
let of Gatun Lake from which the water supply of that town is taken, 
the Chara is dragged out of the water before it reaches the surface; 
this is done by the filter plant personnel to obviate the use of larvicidal 
sprays upon the water. But over the great areas of Gatun Lake in- 
fested with Chara no form of control seems practicable within economic 
limits. 



45 

The distances involved in these flights are much greater than are 
usually ascribed, to the Anopheles. Gatun Lake comes no nearer than 
12 miles to the Pacific terminal cities and not within 4 miles of the 
Atlantic side cities. By far the greater portion of the surface patches 
of Chara are much farther away. The conclusion that these periodic 
long flights of albimanus come from such distant sources has been ac- 
cepted only after long and patient investigation over a number of 
years. There are no other sources of A nopheles albimaus of any magni- 
tude within a less distance of the terminal cities at the times the flights 
appear — after the long dry season and before the rainy season actually 
begins. It is hoped that a series of observation traps can be arranged 
another year at this season in order to obtain still further evidence 
regarding these flights and their magnitude at varying distances from 
the lake. 

TRYPANOSOMIASIS IN ANIMALS 

In the annual reports for 1930 and 1931 the occurrence of trypano- 
somiasis in animals was discussed somewhat in detail. During the 
first few months of 1932 a few sporadic cases occurred in the Canal 
Zone but from a practical point of view it does not at present con- 
stitute a menace. 

It still prevails in certain provincial districts of the Republic of 
Panama and appears to be extending northward toward Costa Rica. 

REPORT OF THE HEALTH OFFICER— PANAMA 
Dr. Jesse L. Byrd, Health Officer 

Sanitary inspection. — The force engaged in this work is composed of 
2 sanitary inspectors (Americans) , 10 sanitary patrolmen (Panamanians 
and West Indians), and 1 rat catcher. The work includes routine 
inspections of houses, yards, alleys, and other properties; the location 
and elimination of nuisances, such as fly, mosquito, and rat breeding 
and dirty premises. The city is divided into 8 inspection districts with 
a sanitary patrolman in charge of each district, which he covers every 5 
to 7 days in a thorough manner. This system has been in force since 
October 1 , 1930, and has proven satisfactory. Owing to the depression, 
nonpayment of rent, rent strikes, etc., many properties in Panama 
City had the water service cut off from time to time during the year. 
This resulted in a substantial increase in the inspection work, for such 
properties were inspected twice a day as long as the water remained cut 
off, in order to insure their cleanliness. Whenever such property 
became insanitary or an actual nuisance resulted from the lack of water, 
the house was immediately condemned for occupancy and closed by the 
Health Officer. 



46 

Building inspection. — This work is done by a sanitary inspector 
(American). It consists of approval of all plans for buildings con- 
structed, altered, and repaired within the city limits; the follow-up 
inspections of such structures during the process of construction, and 
their final inspection together with the issuance of occupancy permits. 
This inspection is limited to the sanitary features of the building, such 
as rat-proofing, lighting, ventilation, plumbing, and drainage. 

Rodent control. — All new buildings and existing buildings undergoing 
repairs are rat-proofed in accordance with the sanitary regulations. 
Eventually all buildings in the city will have been rat-proofed. During 
the dry season, rats were reported as present in large numbers from 
time to time in storm or combination sewers throughout the city. 
Investigation gave sufficient evidence that the reports were more or 
less true, and in order to eliminate them a rat-poisoning campaign was 
decided upon. It was decided to use white arsenic in the following 
formula: 

Arsenic 18 parts 

Fresh frozen meat sawdust 72 parts 

Cornmeal 5 parts 

Flour 5 parts 

This was well mixed and put up in small packages, about one tea- 
spoonful to a bait, and wrapped in a square of paper. Six baits were 
placed in each manhole, and 55 percent of all the baits were taken with- 
in 24 hours. A few dead rats and many dead roaches were found on 
inspection the following day. Evidently most of the dead rats were 
washed out to sea. 

Instructions to sanitary patrolmen. — In order to improve the sanitary 
inspection service, a course of instruction having to do with the life 
and habits of the most prevalent local mosquitoes, and a few of the 
common flies, was given at the Health Office by one of the sanitary 
inspectors. The patrolmen showed a great deal of interest in this work 
and are now able to identify several species of mosquitoes and flies, and 
know where to look for their breeding. 

Vaccinations. — A vaccination campaign from house to house was 
started in July 1932. Up to the end of December 1932, 19,141 
persons were vaccinated, and approximately 50 percent of the city 
had been covered. Most of the vaccinations observed at this office 
showed immune reactions, a very few vaccinoids, and still smaller 
number of vaccinias. 

Dairy inspection. — A veterinary surgeon is in charge of this work. 
Pasteurization is compulsory. All dairy herds are tested for tubercu- 
losis annually and reactors are either slaughtered or isolated. Of the 



47 

cattle tested during the year, 3.15 percent reacted to the tuberculin 
test. In order to prevent the introduction and subsequent spread of 
tuberculosis in the cattle throughout the Republic, and the tremendous 
financial losses resulting therefrom, the Panamanian Government 
should prohibit the sale or disposal otherwise of tuberculin reactors, 
except by slaughter. 

Food inspection. — This work is under the direction of a veterinary- 
surgeon who makes frequent inspections of markets, bakeries, restau- 
rants, lunch counters, ice cream parlors, soft drink stands, etc. All 
such places are required to have a permit from the Health Officer be- 
fore they are permitted to operate. The Panamanian Government 
took over the ante- and post-mortem inspection of meat at the local 
slaughterhouse on November 1, 1932, and employed a retired veterin- 
arian of The Panama Canal for this work. This office continues the 
supervision of this work. 

Garbage collection.— The consolidation of the collection forces in 
Panama City and the Ancon-Balboa district, which was effected on 
February 9, 1932, has greatly facilitated the work and resulted in a 
slight saving. 

REPORT OF THE HEALTH OFFICER— CRISTOBAL-COLON 
Dr. Jesse C. Ellington, Health Officer 

General. — There were no changes in personnel nor methods of ad- 
ministration during the year. Health conditions were excellent and, 
aside from two epidemics of a mild type of measles, communicable 
diseases decreased from the previous year. 

The general death rate of 14.43 per thousand was the lowest since 
1927, while the infant mortality rate of 69.32 per 1,000 live births was 
the lowest ever recorded. 

Alt. Hope Cemetery.- — During the year there were 470 burials and the 
receipts from burials were $3,663, with miscellaneous receipts of $447. 

Building inspection. — All construction work and repairs to buildings 
were followed up throughout the year to see that all sanitary regulations 
regarding rat-proofing, light, ventilation, toilets, etc., were complied 
with. Fifty-six plans for new buildings and major repairs were ap- 
proved and 864 permits for minor repairs were issued. 

Street cleaning and garbage collection.— No changes were made in the 
system of street cleaning, as it was satisfactory throughout the year. 
Garbage and rubbish is collected daily and disposed of by burying and 
burning at the dump. Fly breeding and obnoxious odors were not 
troublesome during the year. Garbage and rubbish disposed of 



48 

amounted to 29,074 tons, 22,194 tons from Colon and 6,880 tons from 
the Canal Zone. The cost of collection per ton in Colon was $1.36, 
and the cost of disposal, 50 cents per ton. 

Meat inspection. — There were 7,383 cattle slaughtered, of which 7,343 
were passed and 40 were condemned as unfit for food. The number of 
hogs slaughtered was 4,250, of which 3,977 were passed and 273 con- 
demned. The 40 cattle were condemned because of extensive bruises, 
tuberculosis, and septicaemia. There were 508 livers, 5 heads, and 15 
quarters condemned due to parasitic or other infections. The 273 
hogs were condemned due to cholera, cysticercosis, emaciation, and a 
few for other pathological conditions. Meat to the amount of 6,353 
pounds was condemned at Mt. Hope and in Colon during the year. 

Foodstuffs, in addition to fresh meat, were condemned as follows: 
Ham, 170 pounds; cherries, 841 tins; pork snouts, 20 boxes; onions, 500 
pounds; chewing gum, 60 cartons; eggs, 9,000; apples, 18 cases; lob- 
sters, 200 pounds; shrimp, 20 pounds. 

Certificates for 4,831 hides from this district were given. 

Inspections of food establishments. — The following number of inspec- 
tions were made : Ice cream parlors, 431 ; bakeries, 486; dairies and milk 
plants, 483; bottling plants, 362; ice cream plants, 305; markets, 829; 
restaurants, 1,225; soft drink places, 1,468. All food establishments 
met the requirements of the Health Department and there were very 
few prosecutions during the year. Monthly samples of all milk, ice 
cream, and soft drinks were sent to the laboratory for bacteriological 
examination and chemical analysis. 

All dairies were maintained in good condition and 1,782 cattle were 
given the tuberculin test. Six reactors were found and slaughtered. 

Animal quarantine inspection. — Inspections were made as follows: 
Horses, 52; steers, 3,791 ; mules, 18; cows, 107; hogs, 5; birds, 26; 
monkeys, 9; baboons, 2; dogs, 10; others, 20. 

Free clinic. — The infant, preschool, and prenatal hygiene work was 
carried on throughout the year in the clinic as follows: 

Formulas prepared for infants 9,356 

Infants and preschool children (clinic visits) 4,912 

Prenatal cases (clinic visits) 784 

Cases referred to hospitals or physicians 445 

Adults, treatments given 589 

Smallpox vaccinations 2,383 

Typhoid immunizations 23 

Home visits of nurse 4,094 

Specimens sent to laboratory 303 



49 



Mosquito and rat work. — All mosquito complaints were investigated 
promptly and any breeding places found were destroyed. Daily 
catches were made at several points as indices and through the sanitary 
patrolmen in Colon and the larva hunter in the Zone all mosquito 
breeding was eradicated as soon as possible. During the year, 3,798 
traps were set for rats and 829 were caught. 

Swimming pools. — The two swimming pools in the city were under 
observation throughout the year and two water samples were taken 
weekly from each for examination. On one occasion it was necessary 
to close one pool while repairs were made to the filter. 

REPORT OF QUARANTINE TRANSACTIONS, CALENDAR 

YEAR 1932 



Vessels inspected and passed 

Vessels granted pratique 

Vessels passed on certificates of masters. 
Vessels issued provisional pratique 



Total. 



Crew inspected and passed 

Crew passed by radio (Navy) 

Crew passed on certificates of masters 

Passengers inspected and passed 

Passengers passed by radio 

Passengers passed on certificates of masters. 



Total 

Airplanes inspected and passed . 



Crew of airplanes inspected and passed 

Passengers of airplanes inspected and passed . 

Total 



Vessels detained in quarantine 

Crew detained in quarantine on board ship 

Passengers detained in quarantine on board ship 

Crew admitted to station account of quarantine regulations 

Passengers admitted to station account of quarantine regulations. 

Persons admitted to station account of immigration laws 

Number of detention days for the year 

Persons held or detained for investigation and released 

Persons deported under immigration laws 

Supplementary sanitary inspection of vessels 

Vessels fumigated 

Box cars fumigated 

Deratization exemption inspections 

Meals served to cabin passengers. . . > 

Meals served to steerage passengers 

Meals served to gold employees 

Meals served to silver employees 



Total meals served. 



Cristobal 



2,935 

111 

14 



24,476 
137,080 
63,535 



72 

509 

2,515 

37 

51 



Balboa 



249 
38 



2,155 



8,163 
7,944 
99,878 
5,652 
6,711 



18,607 


16,252 


243,698 


144,600 


378 


9 


1,297 
1,397 


25 
21 


2,694 


46 



944 

5,275 

9 

403 

650 

9 

94 
4 



490 
4,785 

402 
5,459 



11,136 



REPORT OF THE DISTRICT NURSE FOR THE PACIFIC 

DISTRICT 

Number of baby clinics maintained 6 

Average number of babies enrolled per month 465 

Average number of babies visiting clinics during month 208 

MR 35955 4 



50 

Total number of visits to clinics 4,038 

Number of visits to cases of tuberculosis 62 

Total number of house visits 1,067 

Number of talks given in schools 51 

Interest in the baby clinics continues, although attendance was lower 
than last year. Instructions as to diet and hygiene were continued 
and pamphlets and other reading matter were distributed as seemed 
necessary. 

A clinic was opened at Gamboa at the request of the mothers in that 
place. 

Classes in home hygiene and care of the sick for colored girls were 
organized in La Boca and in Red Tank. These classes were not finished 
at the end of the year. 

A class was also held weekly from June to November at La Boca 
for housewives on preparation of inexpensive and well-balanced diet, 
hygiene and general health measures. 

All cases delivered by midwives were visited as soon as possible after 
babies were born, and on the whole the work of the midwives seems 
satisfactory. 

The District Nurse assisted with examination of school children on 
66 mornings. Saturday mornings are usually spent in visits to Bureau 
of Statistics, to get names of new born babies, and in visits to the 
maternity wards in Gorgas Hospital to become acquainted with mothers 
of new born babies. 

MEDICAL EXAMINATION OF SCHOOL CHILDREN 

When school opened in October a full-time physician was put on 
examination of school children. It was necessary, however, to assign 
him to other work at various times, and the examination was not com- 
pleted until the spring of 1933. A full report of the examination will 
be made in our next annual report. 



GENERAL TABLES 



Table l.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES 

FOR EMPLOYEES 

ABSOLUTE NUMBERS 





a s 

a SJ, 

§ a 


Discharges from and 
deaths in hospitals 


Total deaths 


o 

o 








.3 
Q 


3 

a 

X 


~o 


| 

.a 

Q 


3 

"5s 

a 


"S3 

S oS 

3— H 

MT3 =• 

S fen 

^ C S3 


Year 1932: 

White 


3,387 
9,234 


1,113 
1,821 


1,050 
1,583 


63 
238 


17 

96 


15 

87 


2 
9 


21,151 
57,666 


57.79 


Black 


157.56 






Total 


12,621 


2,934 


2,633 


301 


113 


102 


11 


78,817 


215.35 


Year 1931: 

White 


3,551 

11,046 


1,201 
2,440 


1,102 

2,069 


99 
371 


27 
106 


21 
96 


6 
10 


22,849 
59,450 


62.60 


Black 


162.88 


Total 


14,597 


3,641 


3,171 


470 


133 


117 


16 


82,299 


225.48 



ANNUAL RATE PER 1,000 EMPLOYEES 



Year 1932: 

White 




328.61 
197.21 


310.01 
171.43 


18.60 

25.77 


5.02 
10.40 


4.43 
9.42 


.59 
.98 




17.06 


Black 




17.06 








Total 




232.47 


208.62 


23.85 


S.95 


8.08 


.87 




17.06 








Year 1931: 

White 




338.21 
220.89 


310.33 
187.31 


27.88 
33.59 


7.60 
9.60 


5.91 

8.69 


1.69 
.91 




17.63 


Black 




14.75 








Total.. 




249.43 


217.23 


32.20 


9.11 


8.02 


1.09 




15.45 









51 



52 



03 
>> 

a 

§ 
S 

)— 1 

a 
o 

a 
a 

3 
*o 

X) 

C 


1 
IL»0U5[U{1 | 




t- 


C-l 


UJ • -rt 


•<Mrt -c 




■CM • 


■>3< 


■ C-l 




■H CM 






3 J!T 




CM 
















: rt : : : 


: ':-' 






SI « A 


— < ^rHUJ d '^« 


^H *«* t-4 CM ^* f-t -*3< CM W5 rH IT3 <M ^H • 


■»HM« ^H • 


" 


91-01 




- 












: rt : 












01-8 1 

1 


~ 


':" : : : 






















8-i 








i- 1 : 






















Z-9 j 
























« 




9-S 






























9-f 






























1 


« 


























£-Z 






























z-\ 






























>. 

-3 


n^ou'!|a 1 q 






























18-99 1 








:~ : 












~ : 






- 1 


S9^9S| 


-* 




T»< -H 


■COrt CM 




m>~ tj< 


: rt : : 




- 




se-is 




eq 


-CM *^ • 




CM 


rHCM CM 




:"< 








OS-9* 


~ -" 


'•■* f-H '• 


':-' : 


<M ~H— . 


• - 


• -^ ^ -^H 


•^CMt-i ^H 




s^-it- 




CM 


• <M ,-, . . 


-"*-" 








CM 


i- 1 : : 


: :- 


- 




ot-fle 




•*« 


:** i 1 - 


: : : - 




~ 






- : 


: j" 






fi8-T£ 




cm 








- 






:" : : 








0E-9S 




CO 
















i- 4 : : 


_ :- 






sz-is 




- 


























os-si 






























o 
Q 


3(DBlg 


^H Cflrt QO UJ . . r- 


*^CDCM CM U3 t-h ^ CM O0—<a0 CO~* 


-i>HtO« N«i-< 


atlHAi 








<N« -^ 


::::-< 




CO»H rt 








^ 




SU1E9P l"C10 T ^* SO'HCO t^»-H»-i^H,-lo<M CO W3 »-t t~ CO O3^H00 mrt ^rHwOM CO *H ^H 




Q 


- 

: 


' £? : 

! o • 

:« ! 
■'p. : 
:§ : 

?l : 
■ 'o : 

hi 
II 


_^3 
"3 

03 

I 


3 

■g 

d 

S^ 
£ ■* 

5c 


Cancer and other malignant tumors 
of the digestive tract and peri- 
Pellagra 

Disease of the spleen 


Simple meningitis 

Softening of the brain 

Endocarditis, specified as chronic, 


■ « 

3 » 

3£ 

i| 

3 00 

is" 

- B ! 
3.2 ! 

5 2 
.3 
o 


■ a 

■ p 
:=§ 
; ti 
: o 
. >> 
:S 

■ <i> 

5*0 
3 w"^ 

' m^ 

Z 71 "- 

j. a c 
ja 

o 


a, 

§ 

g ' 

? 

1 


: >> : 

• cl • 

■ a 
J o . 

3 ° : 

a"3 . 

^ <n ; 
a o . 

_ si ^ 

J. £2 x 
1 o " 

||| 

>, St: 
<■< 


"3"! 

■j: c 

5 ; 
■9 i 


Other diseases of the respiratory sys- 
tem including gangrene of the 
lungs (tuberculosis excepted) . . . 


O ■ '■ 

■o^ a 
■3*S c 

►Sao 


Nephritis, unspecified 

Other diseases of the kidneys and 
ureters (puerperal diseases ex- 
cepted) 

St.riotiiro r.f the nrofhrn 


s 

1 
5 

-S 

i 

5 



53 





CO — 








o 














Ttl 


--- -1 


- 


o 














IN 














CI 














rt 












1" 
1 














































« 




- : 








■-< 












































^ 






- 








CM 














CO 


-eq : '— 




OS 
1M 




<M-* 








CD 














CO 










- 


iO 




- : 








t-- 














- 


















.-c CO C> i-l >-l i-i 


CD 




N i 






It. 


^ «C^ —!■-<>-« 


CO 


e 
_o 

rt 

to 

§ 

c 

1 

g 

31 

- i 
s ■ 

< 


I 

j 

c 

— 
- 1 


• br 
'3 

aa 

c.S2.!2 

a a 

« c3 t 

-b .fex 

c c c 


c 

_e 

c 
E 
c 

1 

4 

z 

pi 


> 

J 

C 
"J 

| 

= 
— 

E 

c 
; 
- 


. 







54 



Table 3.-DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF 

PANAMA AND COLON 



Place 


Popula- 
tion 


Deaths 


Annual rate per 
population 


,000 




Total 


Disease 


External 
causes 


Total 


Disease 


External 
causes 


Year 1932: 


77,500 
30,000 
42,070 


1,232 
433 
307 


1,171 
405 
272 


61 

28 
35 


15.90 
14.43 
7.30 


15.11 
13.50 
6.47 


.79 




.93 




.83 






Total 


149,570 


1,972 


1,848 


124 


13.18 


12.35 


.83 






Year 1931: 


76,000 
30,000 
40,565 


1,341 

482 
305 


1,274 
457 
247 


67 
25 

58 


17.64 
16.07 
7.52 


16.76 
15.23 
6.09 


.88 




.83 




1.43 






Total 


146,565 


2,128 


1,978 


150 


14.52 


13.50 


1.02 







co i te 
J5P3 o 



56 



P >> | 



-« ■» «r» »<»* cn cm 



CM • CM .-H 11 



^lOMm^MINSfO H«C«lflOHHH 



*-« CO kO CO 



rtTH -r^CM-H 



w O »-* ^3 i-t -*)1 1-1 



1-1 (M _l h CO ■-" "H 



1-1 (M CD CM CO i-l rt 



~H t» CM QC cowa 



H5-HiJie<|i-<-»f1iOCM 



IrtUi^iOlO 



IOiHCOlCrHrtloN*MCNIMCBlO HClNSSOOHi 



CO CO OO CO ITi 






.2 « 

^a 



-S 2 
tj'S 



£ p3 = 
*" o JJ'3 

t: o-S a a £ S'ra-S 

".&«=§ >,>.£■ 2 



tl 



fi Sj§ 

~a 3"S S 

a'fc a-s 

CB O..S § 

m-o"o >>"">» 
;- ™ to.s » o 

"S m.2.3 ° „- 

.— fl "w a-7"-;7 

2|.sl|l 

o o o o s_ 



i 3 S 

■ aO 3 3 

■•Jg 3 CJJ 

: S S^ 

61 o a 



oS 



c3 a 

H " 



• -= o _;:= 



a 



la 



S 8 " I £33 «"^«J g 
a o 3 3 -2 a a ^13-^^g >, 



S c 2 aJa 

•S-S-sS-s 



o o o 



So o 

S OS s -— OS « 



3 3 

Cj ."3 



a ; 



a a 



a o 5 

is-s 



3 3 
Cfl « 
OO 



57 









































































*"' 
































C~ 




'" H 




















CO ■ 












to 














CO .-< 




— » kT3 -* -H CO -H 
CM 


















oa • 








""* 


CO 










"-' 










""S 


CO CO CI 








CM 








CO*-l 












iO 


















i-*CO 


CA 


<M 


U51-I-H 








~* 




*■ : 






^ 




CO-* 










** 


rt 


CO 


OOrt 


rH T* 


'- , 










CO-H 00 ■ 






























rt 






CO-H 




** 


""■' 








i-ItH 


■» . 










*" 








r-< rl 








-HCO 


rt 








-,rt 


" H 








CO CO • 


*■' 














1-1 




"* 




















""• 














*■* 














** 




















IN 


* H 












~* 




*"• 


























COM 












CO 


ro 












CO 




-H rl 








































rH 


CO 












"""' 
























C\ 


K 






Cn 


C^ 


r- 










Cv 


c 


C 


X 


s 


"■ 


cc 


ff- 


— 


1 


u 


>«- 






C 


>d 


c-- 









'"" , 




W — I 


i" -1 


.rtrtrt 


CO 




ro 


oa 




.-KTO-H 


~* 








^ H 


CO • 




Mi- 


rt-H 












CO co-<f 


COrt 




















■»n 



















rtlOrt-.rt-i 



Hon^eococooi^co-^ 



I CO -H -H CO CO 



co*"cncoooco*ot^**fCO'*f*t>.»-Hcoeo 



) Tf -^ CO T-H 



fe o 



S 5. 



« CS-^ O 

mm o o 
"rt*c« 2 2 



'•ST3 






^qphKQo 



>> o 5 g 



— '~ o 



i.aiJ 1- 



i-3 



^ "* CO © O "^ ^ 

io.S S S-2.L ^"3 " 

"I 3 II I °.s a a 



-.3.5 c.S 



'co: 



<! Q HSOOOMWOQaOOQQ 



3 c -3 



T3cg-a 



i-ra-o-o n-a 



58 



•-^<<M OO^ih 



. _ H i-t ■ "^ ^ COC3 



'ONN • ^h . eo 



■KhNOhOOOW 
• .-* !>. 1-1 






iHMMiOiOO^OWOMWW O 
^H CO VNH 



-^ -OS -HO) • «-* *-* O ■ — • 



CO • tO -H 



I rf COC^ O* C* 



-h — . uT3 <M ifl ^H tv. O CDNM 
CO ,-1 *h ?CI 



00 co-^ 



■i-H M t>- 



(N »-iioti< 












"3 °*S 






£■£■■%£% 



— -» »» <u „* o a 

5 @ 



o c 

°1-2 B-l' 



S» -p-p-a : aa.!ngasS'Sc-=: 



'S. 



cSco 

sgga 



» a ^ §.3 

5 o o g--g g S-g : 

5o3mo jchSsu; 



>,_o 
o g 



c =« 9 



u'-O SB'S o 

So P5 



59 

























































































CN 






•"* 


CM»H 






































- 1 






■"• 




*■""■ 


rtrt 






o»cni -H 






*»> 
































n« 






X* 


""* 




i-l -HON'* 






^ H 


rt 




























cnkncn 


rt 


lOH-H 




i-l rHOOM CM-HNt-I 




-H « 
























mn 


Tjli-H 


Tj* 


Hrt«N rttO 






"" 








(N 


""' 






■-•cq 


rt : 








CM 


T)<1-1 




*"' 








Mia-H 














-H -H 




CN fl>rtH t-I 


~ 








CM 


CI 












-*-H 


-^ 
















1-1 




pH 






CM 










rt rt 








in 










* H 








































-« COCO 




1-1-1 












l-l o 




CO 


































cn««o 

co 


rt 


tM 
















>o 




CO 




































" 


(M 


**' 




c) 












cm 








*" 




























n 


DC 


e 


OC 


■* 


s 


** 


*"' 


■d 


IN 


na 


C) 


CN 


Tl 


cn 


■re 


cc 


00 




so 


™ 




■-* 




hQ 






~ 


CN 


^ 


e? 


US 






- 



*-« co e* co ^h «-* 


W 


1 " H 


Ni- 


lOOCS 






























*"* . 


C* OS r-t Tf i-« CO r- 


•CSC5 


T-H CS 


CM^ 


t-CO CO 
CO 


CM 










iC 











■*t 


c 


ur 




■H — 



CNCM^Oi^t^COi-iCO 



OM'J t^lHMNT}' r-l 



■^— <c»coiOeo^j''-«coc^TfC^Tj<co 



••OO Ol'-iCOCN'^ «-( ^h to .-« 



r-t i-H C^ -*J« C^ 40 fH rH r-l 



» ™ ° 
§ 813 



3 °J «;£ 



° CO 



» ft °-~ S 

: to c — .c 
- _ „ <D — 

3 » a ^jj 
>"»"cu ^'o 

3*" ■" ft oa' 

|^o£ g- 

3.2.2 c3-2 



•a-g 





CO 








a: : 


CO 






















-o 


























3 




























s 


s • 


-a 


a 










. 


o. • 


^^ 




















-SI 








o '■ 

a ■ 

a ■ 


-3 


DC 
O 














=a-T3 






a 




03 




CO c 


S 


3 


O ; 


a 






09 


C9 . 






:-> >> 


a 








O a 


co 


J3 


a • 


a 


03 


w"S 


ft a £ S M ■ 




H 


-a-* 


>>J3 ^« • 


*> S 1 ^ 


ft hi 

ted) 
rina 

fthe 

pro 
ma 


5.g| 


p 


C 2 




x 


"j: 


-a • > 

43 ■ O 







« c u » c a O'M*' u « 5»« 



a a i 

Coo g 

' M-3'E^ 

i * g^fe 

: ozo 



a u- 



o o 
i O cb.S co n 

' 3 -g 5j cs cs 

ObOQQ 



! IS 



"Sj35 3 

WOhOPm 



3 ft.£2 

1*3 l'2-I' 3 

: S S =o Sua-g s 
o 3 c3 cic-r; S t5 

b a g_afto"3 



60 



1 

>. 

< 


a 

Mag 
< 3 C 






























o 
o 

1 
























00 




1 




* H 


CM 














C33 — 1 




o 

CO 
























"* 




o 




CM — 


















w 




o 

1 

CO 


~* 


CM 


















CM 




o 

CO 

1 

CM 


*"* 






















:*■* 


o 
1 






























o 
to 










T-l 


















I 








*"* 


rH .-. 
















1§I 


~HCO 








t* »-< 00 CM ■«* r~ CM cO~h~h U3 

co^ -hcm ~h 






o 

o 

O 


>* 






























a 




UO CO CO 


~< 10«r~CM CO CM CM »0 CO ~H ■** to CO 

CO-** --. 1-H ~^ ^« 




t* 


co~ 




^ 




CM • ^"J" 


^H C 


3 ■ « CM ^ rt 


DO 


fe 




■» 






• -, CM . 


-H CM 


CMC 


> • lO CO 




S 


cocm co co*-" 


M^«C-H r^cO CM •^^HrH O U3 -^-h 


~5 ja 


eo to co co ~« *^ lonon ** f- cm to r- -h io oc -^« ~« 

*-* CO ■** ^H CM »-< »-< 




-o 

O 

=> 
S3 
O 


.3 

.s 

■e 
e 
e 

•2 

1 -1 
S < 

p 


3 - 

: 

- 

1 

a 

r \ 


• o 

;ja 

' o 

s 

• 03 
B8 

■ b 

s 

— 
d 

: o3 

r C 
Q 4a 

> o 

1 a ; 

5 ■ - - 

!§ 


: | 
: "s 

'. S 
o 

si 
• -o 

; -« 

; S? 
! 1 i| 


! ' 

I 

• 
• 

3 

^ - 

X 


■is 

jJ.S 

ij 

3 H 
| ^ 3 

5 J 
3 | 

2 — 

3 P 

o *j 

3 ~^ 

' S 

"5 
3 ' |7 

z i 

3.1 


Congenital malformations (stillbirths not included) 


Other congenital malformations 

Diseases of early infancy 


: o 

'■ a 
• o 

:S 

< a 

C3 a 
*o'-3 

>- 2 

C3 S 
S§ 

— ' a 
■a b 

B CO 

J3 . 
It- 

'■S.i. 
tu-° 

l"Sl 

CO >> , 
§b = 


• CO • 

:-o : 

. C3 . 

■ 3 

'. b : 

. O . 

'■ « • 

: a : 

. o . 

! b :' 

. C3 . 

: « :" 

• -^ ■ 

■ 3 • 

■M '■ 

• ■g o 

?&a 


; b 

. o 

: : a 

. ^CO 

• a o 
ill 

:~S >> 
s-gg 

S,S>| 

«CO-S 

3 £-£■ 
i b § 
= 3o 

Jj 

'^■3 

Eg8 

2 b a 

J3j.( 
j-2-B 


'. s 
: c? 

3 ^ 


FiofcHi ok</ accidental deaths 

Suicide by solid or liquid poisons, or by absorption of 
corrosive substances 


3 

i 


g 

5 
bl 
a 

5 

3 

3 



61 



• CO «-* i-i ^H - C3 



■CO-Tf* r-iHN ^H 



i-l rHO) 



■ tot>- • »-< o co ci i-ios«-h 



i-ie* i-l 



■OO^H . rH" 



"**« -»«tl-HCq HH 



|lfll-lHH'i!NHHlOt 



i— I C$ i-H .-* <M ^P <N t-l »-w i— i CO i— I ■**< *-t i-f CS| 



NmHHH^OlHHCN C^ HfO'HrtlN' 



N HMrtiOHr)( 



I a 9 9 a 



9 a 8 S M 'Js 

S s.S— . w g a 

£ a3 o3 d & § 
c u °b 3 2 « 

ifl ^1 ^>^ -Q "O -«j , 



i'ssa 






X1J2-QJ3^3. 



cj s s b a a 
Its -a -a 



3-° 

-a-a'E 



'3'3'3'3'3 ooo§Sg§ g g g-gi 






<:o> 



jgl 

°.2.g33 

l|.a? 

-S-3.2 fc~ 

•sig.a^ 

g-a-S^J 



- S: §1 
I. I 

B o 
O C3 

III 



5£3 



62 



-&— a S 

._. o « a 



o-*»> oo 



~*r-CM co-h 



g"d > g 02 <D D 



M C3 

.HZ 
.3 a 

w a 

3 



S^2 >S°2 



tf C3 






MNt^OMN NMCONMCO O CO 

h!oon»o o«^«>H--a to co 

OOOOOO OOOOOOCfc oo 



Or^-rfX^ioOOO 

ooooooooo 



Ph C3 



rHOO -COT* • *-l C3 »-l ■* 



(M CO to -3* 



rtOnmn 



OS CO-H 



3 -a > g a) » a 

3 <*z« s ^a 



-3 



.5. C3 



.22 
J2 a 



CM O »-< CO »0 »^ ^ lO N ■* M « CO 03 U3 



• t~ OO^H ~H rH 



» 5 



"3. >> 

a b 



a cj 



i « 



o.2 



i 5 i; r" «o 



g* O 

CD.! 



■71 2 



o o, 
o o 



aij2 o 
o _ C 



_g-a- 
0*0 



O O ™ O 0_^T3 C3 

S|.&li &&B§i-§J ■§•§ Jill' 9 



a ca 

O^ 



s s 
3 a 

■*= a a 
° a S 
s •»•£ 

fe E a 
8 55 S 

a o 



S3? 



63 



«3 

w tO<£ 
«*« O C5 


coco CJ CI 
OO O O 




CO 

O 


to t^. 

<M r-- 

oo 




CO CO CO CO 

oo oo 




cO CO CO CO 

cm <-i as— < ~ 
o o o o u: 






OS CM 
COiO 

OO 




CI W 

c 5 




coco 
oo 


CO 


O «n co co 

O COCO CO CO 
CM OO O O 






CO 

o 


<o CO 
COCO 
MO 
















coco cor*- 

CO CO COCO 

oo coo 


coos 

CO OS 

»H O 




p* 










































































<«* CI ■* 

CO CO eo 
t-t ©-< 






CO 










cj 

OO 

o 


CM 

o 


CO 










CI 

eo 


CM 


*0 
CM 


CM 
OS CO 

-«*« o 




tN 

CO 

o 




*o 












LO 


















CM 


*0 














CI 

»0 


















































































CO 




— 
o 






o 








as 
a 




5 






OS 

o 


OS OS 
0»H 


t-* 

COOS 
TjiO 














OS OS 

oo 






































*o 
































c 
c 


a 


C 

c 
C 


C 






CI 

c 


— 


C 

c 


I- 

c 


c 






— 


c 

? 
c 


C 

c 




re r* 

— c 
o ~ 


PC 


C 

<z 


CO "*»« CO COCO t^- TT CO t^ C>» 1^. CO CO 

•— ' OS ~* M CI CO ^0>h(Nt)iOhh 
0*000 OOOOOOOO 



CM HO O i-4 i-H "*< ^ 




rt 


CI Xi 




-M«-h ^ CM 




cm -nr^^HO 


CM CO^t* 


Tp^H 


rt*H 


UO 


CO — t*H i-H ^H 






rt 


COi-i 


















^i-4»CCN 


-^ CO 




CO 
























































*"* 








rt 










CM »"H tM 






<M 














CI 












** 


C- 


CO 


CO i-l 




" H 




rH 






CO 






" H 




















1-1 


-H 














*"■ 




















































































»o 




^ 






'"' 








TH 




*"" 1 








■^ 


— *CM 


• O rH 














^H^ 


1-1 





































































CJ CO ,-t i-H CO CO 



NTfNOOCOiO r- Tt< CM ■** t~* «— i CM C 



B-S 



o o 

° 2 

aa 

3 3 



2-c a 



o is 

■asfS 






S'O'2 OJT3T3 



S3, o o a m 

gaa-ss 



C3 03 • = B K*3!a 



~ c3 c3 -^ O 

g a ew!^, 
C..2P.SP ° ° 



•-S b S" 



O O OO OO 



^ J ° ° 

1 1 1 a 

ZZhh 



cj.s 
3!s 

a = 



^S'ti wj o o^3 a 

b.s ^ a-s^; « 

^ a 09 ,^L cx'Sd 

5 H^rsra a oi, 






H-a 






S(£S'qo £i£e-.q < S HoaOoo&Bw oqhcSoSq 



64 















co as os 


o co co *n 






OS CM 




iO»« 


COCO CO 


CO 




CO COOS CO 04 




CO CM 












CMCOCO --HHCO 00 ■ 


COIO • 


iO CD O «-h CM i-t 




rHDlNHlOlOrt-H 










i?<„ a <* 


ooo COOOO CO • 


OO • 


^h O WOO O 




OOt-hOO»00*9* 










j? o c3 a 


































.&<-.§ 


CO 




CO 


o>co 




cocococo oscoco 








cot- 1^ 


CO 










CO 




CO 


OiCO 












CO CO CO 


CO 












o 




^n 


OO ^ 




O O « O OOO 








H009 


w 










O ° ° 




























>» , >s ^ a -C3 *-> 






















■a 






























o 


1 




Q 


a-a >«»»S 






















a^ 






























o 
o 


o 




















































































3. 

| 

M 

C 




CO 


>i 






eq 








C4 


CM 


CNlTtt CN 


















s 


rr 








> 






irj 


CD 






Oi C30 




OOO l>- 


















5 


GO 


B3 
Ph 




5 
< 


bfi C3 

.£Z 


o 




O 








•*o 


O 


Oi-h W5 


















HT 








































oo 


>o 




Ph 


a ca 








N 
















•C^ OO 


















CI 




w 


_3 


H 












"5 














CO 


■ WD O 


















■a 




H 


§ 


o 




H g 


a 1 






1 














•*: 


■ ^H O 






















< 

P5 


5 






< 


■< ° 






















































































5 


DO 

no 
O 


•< 

D 


g 

DQ 


< ^Z'g C;~ a 








CD 










































>> 


g 








-«* 






t*. t^» -^ 


t--b- -^b-t* 






t . 


-fl- 












□ 


> 










~ 






010)05 05 








■a-. 


ai 






« 






z 


.si 


o 














<M 00»-i 


oo ~oo 






o 








O 








< 


"§"a 


































































































































J$ >> 


■ i 
















Tf 




OO 






































W g 


a § 
















iO 




o 






































< 


<! " 




















rt 




































ot-r-- cMt*-r— o cot— cor- t-- t— i*- 




t^ HHH CO t^ 










"rt 


CM CM CM QOO«f lO--<MOO<NtO ON« a 




OINOlcO'J'NOifl 












OOO CMOOO COOO^hO-hO BOO C 




OOOOOOOCO 










£ 






- 










-£■<_ a a 


CMCOCO hh^t^^^io O 


CO^J" 


C<J it} OJiHN ri 




rHNOrHT^OHM 










CM CO 




^h CO 




^H CM CO 










•- o a 8 




















O Ph § 
















•>. c 


_ 




CO 


«H CM 




rt _^,_ CO«-H 








^*CM CMr- 


CO 




























CM 






>, 






•- O o 

o 


























Q 

oo 


| § l|||a 






















rt 






























o 

a. 




>> 

> 


a 




« 


(N 






CD-^ 


- 


^H CM l^- 


















■Q 


CM 


K) 


g 




a 


Cafi C3 


-a 






































pa 


cm 




< 
Ph 


■9 -a 

J2 e 

73 C3 


O 






































.J. 






^^ 














U5 


■r-l ■«* 


















^^ 






_5 
03 


c 

tsa 




a 
■5 


2 c 






















































































o 
m 


Sh- 
CO 

< 


< 




g T3 > g 0J CJ a 


















































►J 
►J 




m 


>> 

> 


| 








<N 






MHHIM 


T-tlH CM-H-H 






rt 


CM 






•a 




< 




15 




.a 






































.SZ 


o 








































"a "a 














































































"3 « 

w a 
3 


a § 
<< 




















(N 


































— 


co-^Tf c^^HHjita co cm -«j« co >-< oo o us co •**< •- 




T-HCOHH<U5COCO^-iCO 










.#§ 


■*)< lO r-. ^Hrt ^< 




»-H SO SO 










H 










































^i. 


."5" cij 


-a 








>. 






•a 












s 
















i 




."3 o 

- c^ a 


S 

-3 


: jfa 

° 1 

• a^ 

' >>.2 

•■* d 

: II 

•§a 

T3 a 
So- 
il § 
Cja 
a o 


p. 






■ 03 


o 

p 






'5 
ja 




■ 1 




C3 

_6 




Ec 

CI 

o 














01 

i 
5 


Si 

a 




T 

j 
] 


■ « ca 
■T'c 

'CO 

! = „ 
'•3* 

''is « 

- 3 _ .^ 

'§'§ [ 

« «*7 


a 

|i 
|i 

?=€ 


1 

•a" 

a 
'-5 
SS 
o 
>} 

a 

ja 

.£ - 


t 

C 
t 

c 


[ 


; o _ 

3-S4; 

IT 
•ll 
"Si 

c3 > 


1 

~ ■■- 
-i: 

. o H 


c 


e 
.- 


S 
-a 

e 
"S 

^ - 


• ? 

• ^ 
(5 


c 
F 

c 


a 

e 

XI 

'"c 

s 

-a : 

o.S 

-V — 


'3 


>1 

>o 

-5 
a 
a 

-o 

- ; 

. - c 


- 


2 
a 
o 
5 
| 
. a 












o-S5o>oS§S''3 S.5|o S S'fe 8 SiSS c 


■ 


gincc B-T; rt 












•C-a-o-o ■giS° j«ScjsS oj3« 




S S o P--Q 














p 


ft 


& 




E 


5 


2 


§ 


c 


)< 


£ 


s 




< 


c 


5 


3 




c 


£ 


PC 


B 


S 


PC 


w 


o 



65 



_« co co cd co 
<M~h©QO 



CO <M OS OS CO OS UO CO c 

»-«»ococoTfOoicoo<: 

OOOOCMt-H^HO^HC 



• CO CD CO CO OS CO 
'i-i«HW CO <M 

<*-«0©© oo 



co m o» eo co 

r-t CO CO CM w 

.-* t~- o o o 



CO OS 

oo 



CO 
CO 

e*o 


CO t~ 

CO cc 

S c 


CO 

c 






l^ CO CO CO CO t^ 

CO CO CO CO CO CC 

■-.OO'* —<a 




co r~co 

CO COCO 
OOOCN 










C 


COCO 

coco 

CIN-i 


0Q 

a- 
o 




3a 
o 






coco 

CO CO 

oo 


CO 

o 














«C0 
































>o 


























■CN 

•00 

o 


00 CO 
O ~i 


















CO 




CO 


o 








CMTJt CM 

OOCO oo 
O— 1 o 






O0 

o 












































CI 

>ro 












CN 


























CD 






























COCO 
































oa 










Oa 

o 






en 




o 


OO 

o 




Oa 03 00 Oi OS 

O HffiO H 












Ok 

o 









































































— IOOOO 



t-~ i*- r- r*. r- co t>> t— t-- co t^ co f~o 

CM OCOMCN-cMCOCOCOCOfNOCJwN^ <M ■* 
O OOOOt^OOOOOO-HOOO OO 



^NCO CO O <M ^H CM OO CO O 

HlOO OOO OO OO O O 




X) 








N 


IM 




• W3 i- 1 rt -^ *J< CCJ •*-lCN'-lCO • • • ■ i-H CO 


c 


■* 


CO 




■CO 






,H 


*~* 


* H 


























































































rt 


— i CM 




~H CM rt 






"' 




























1-1 




































































































CM 














rt 









































■* tHOiTf'^wMMtOCO'cP'HQOC 



MOO Oa ~H t 



I TJ4 — < —< ur, ^ 



S 5 

VJ O 

s 2 



II 

>.-Q 






cl,SpiO<;o 

MR 35955- 






ceo 
N 3. 

£-a £ 



u cd T3 
C3 >» C3 



^S 






3-o^-S- 



i O T3 



cd-^3 

ejeg 
Sc§ | 

Sli| 

eg c C-a 



E ° 






2 E B 

5 cd ce 
.22 c; cci 

" *" Si fc fc " 3 

2^5.2.2 gfc 



2-e 

c3 °3 

° a -S 2 
■g'-S S >,J3 „ 

»> Si fe *a ja 



goocg. 
■59 .23 .£2 cs.JS 



la's ga S^3: 



C9 






.§•■§"3 s— 3" 



O.3. 
•a-a 



3-Ji -a 
!fflO 



• ».a 



o."3- 



m'o'3" 



•? ozo oko (3q 



66 






.555 

"2 "° 



a * 



^^H -*>S c ^ 
< ^3 § — 



N co <X> 

ooo 



-3 « 



oo 



CO «-t 0> i-» 
OOOO 



r*- 1-- co t~-coco t— i>-t>- 

OO^h (M ^h CO OOO 

OOO ooo ooo 



C^l ■«* <M 



OOO o 



i-t . e$ ^i-iw 



fOtiNiH 



y-4 CO !-• 



a 


0) 


s 


SL 


u> 




!<5 


g 


W 


,5 


H 


P 




►-1 


TtI 


U 






<| 


111 


O 



bO C8 

.sz 



r S *"> 



2 S oijS-o "S 



ho tf 
.2 <3 



s « 



rtHN ■**£ 



~-< ~* r- 1 ro =© eo 



•-H -H >Ot-HOC 



o 13 



«■ c. 

§21 



fe « §.2 S'-s 

§ : ^illolJll 

ig>£ qo^.S g'-S J; a 

m-5 a »- a— £ — *o °'S 
"2 c3 3 ?*« f 3 o £ n a u 

B.8Slfe a rtC.S3 Q, ' T3 *- S3 
-8 £-fl 53 53_a 53 £ ~a 




















. X 


03 


3 






















































T3 


"5 






tf 


53 


03 


e 






a 


J3 

3 


.3 


5s 






■" 




o 










s 


| 


| 




ojct.2 










O 


-2 


a 


3 ° a £ 










~ 


= - 




gala 


















I 


e e 




> 

-c 


& 


i 

3 


'5 



=3 %^ 



•g a.o a a 
g. oo 2 ao S3 

O OtoOO 



67 



OS l-» «-< irp (i-* C3 ^*J 

t-h OO CS) lOCO»-» CO 



IQ CO»- 



■CONH,«{ 



CO CO 
O-H 



• cocoas 
•oo^-» 



• OS OO OS , 



5<M CO '-OTjit>. 

1 CO t-h Oi-H O O 

• * o t-h •© t-h 



10—<OOOOt 



•NN^ONSON 



. t-- 1— !>• co t^-eot-r-r- 



OOOi-tOOOOOOOOi-H 



JOO-*^ t-h O GO © O — I <Mt-hOOOOO<M 



OOOOO OOOOO^HOO 



r*-0 <M CS CO»-H CO 



■ iO CD rH i-t 10 CD 



T-H OS ' 1-H ■ CI T-H . ,-H ,-H O 



(Mi-) • T-l 






HM T-H T-H 



UMlCrHHHHOlT 



w CO *-h t-h <M Tt< iM t-h . 



1 ° rt .2 

i-3 O g 

,-.»§■ 

, a 5 2 
^ a 8 



'g.S 



••- m B B.S' 



ll*l:ff 

66,3 ~ «, 



" 8.2 

° « "i 

, o"8 , g 

°"§ | 

0* C CO 



.S ft 

a m 
'33 



tii 



t, 2 ° M 

-^ o a 5 ™ - 



•ftg.E 



a <u 

3 &: 



ft Si 2 ' 



3 g M-2 

_ a a a -a a^ 

"S £5 o & n rf g 






Jj=-t3- 



^•J3 >* >> >> >> >> >i n, m -n '3 rt rt rt cd 

CD "5 CD CU CD CD CD CD-g-~-§ "5 S 8 g «J 

"23333S-a'3'3S"g-o'g ^ 



— 



•S'S'S'ES'H-ta O 



d'3'3'3'3'3 © o o 3 cd t> o 



•gg.2,-3-3 



3"S.2 , <* 
3.T2 .2. 2 

^ S ft 









68 



i „ 



■1-1 CI • -H ,-t ^H 






c».-« -co^^e^ouM -o • *- 1— i ^h 



"^ -rt W-"H>H 



.QOi-t^H ■ C3 ■05«rH-«0 . .00 






■ CO - ^h • ci =C 



■-O-hhiN -O 



- 1-" CI ■ ~H 



E-.S 



'NHVWHMfflnrt-HMNHMr*H^HH^"M^MHHMNH^«HrtHanHrtnHO«HrtNHH01 



C3-Q 






o_o_o 

•JB333 



£ a 
£<3 






3.— : 



S •> ° 



D ot ^ rt 



C8.S O 



O o o o o o o 



a c c s c c b-3-3 
c c 3 b S 3 c 1 — <9 



e?Sc 



OOOOOOOB^^ 

■a -a -a -o -a -a -o § 2 H 

C C B B B B 3 & 5 S 
C3 C3 :3 rt C3 C3 rt — ^jzj 

ai-ii^j", SBBECBBBSa 

£s,S<dSouooooozh<: 



:.s 1 1 * 



l?.131i 



5c: 



>1.5 3 
t. S 3 

■a >.? 



5§ 

"3 3 



« §"2 

-OT3tC 



aaSS 



°Jt1-5-a-a-333 — 



> « ="2 






o-a 



3"^ 






69 



« ei co <— t 



■CONHMN 



■KM UOCOCO -G^^-H 



■ i-H - -~HCO 



*-h (M -C^ 



• C* ■ i-H ^H 1-t -CO* 



.^H^H^ «5-^ 



■HCON^rt, 



CO CO -©HNNHtOH 



NiOi-(NcO«TtirtH CO^>-<COMWCOlM«OiHi-iHO'-DMHi-ii-iClHH^CJMN» 



UNCONi- lC<)t s -CO'Tt"-'CO'-iCO'-<'-< 




> a.s gp 

5? Sqa 



a 3 



B-Sl 

.5 "8 

« 1 1 n 
-Qt3 






g c.2 

T3-S * 



es-o. 



■= -a 



(S^iSbhCO UOOQ 



.a;g.3.8 g g g-|35'£-l 1 g I l"S3l-s|S3 



70 



Table 7-STATISTICS REGARDING AMERCIAN EMPLOYEES AND THEIR FAMILIES, 1932 





Annual 
death rate 
per 1,000 


White employees from the United States: 


4.78 










Total 


4 78 






Families of white employees from the United States: 


3.18 










Total 


3.18 






White employees from the United States and their families: 


3.73 










Total 


3.73 







Number of American children born on the Isthmus during the year 

Deaths among American children under 1 year of age ;■■••. 

Infant mortality rate among American children (number of deaths per 1,000 live births) . 



211 
3 

14.21 



72 



•»«« -~H • -»-<0^"-l 



■ w 10 *o - — «eo 



°a 

>> IS 

.— b 






inw**H^ 



■ eo c* «-« »-i i-H i-t 



• o* oo ui c* ~- o 



■HNONrt 



••* QOt>-Oi • CQ 



E > fe H 



'COOWM-HINU5 



•®MW»M(NN 



«3S s^- 



-3£ 



■«5-*C0«O 



HrtMHOMOMtOCCO©' 



• KSrt^OCDMNrt CO i« ^H CO -^ C^ C^ OS tN. U5 *H 



««CO -HrtlO 



-a 

o, o 

° b 

i "Sg- 

55 a I 



CU3 

5 Q. 



— 3 






£ b 



b_ 



K S S'oS 
o & eSl3 > 



s c — 

«-b 



HHtfS,: 



A P 

M.g.g rt « bbbg^ 

3..B.B c c 

§5-b 3 3^, 

a. &.&«<= >. >, & b g -g "55 



Mil's 

.B.B.rj.a.aJg.'Sja-g % 
'o'o'o o o^ o^ o"^. 



c s e a 



i o.2 

fttog 

o a a 

-B efl 



NNM^ 



£?J2 >■> 

lo-J 



°. . a 



_6_o o_o_o_o £.0.0 J2 

33"3333"T3333;^i 

ouooooc^cju ^-^ -j^ ^ ;g ;2 ^3 

B 3 BBSS 3 3 3 o> >>>>>,>,>, O 



73 





ua 








CN 






















cr 






















CO 
















CI 


















■^-H 


w*NC» 


t-OOOH 
lOCO 












CM 








,-< -^ r-< IHN i-t^H CM 


ua 

cm 




IQ 


*-*CM 




CO 


■^ii-iCO 


^h tT COCO 
-*" CM 










CO 1-4 i-l 


b- 








CO 


ooo 








CO^HCMf-l 
CM 


t-. 








t^CO*-- 










OSCM ^h 
CO'-' 










CM 




































00 






*H CO 




Oit-t 






r*»c© 














Tj*TfiCN »h CO 












w t-~ 


C^ ^H (M CN 


CM 




"01 








CO 






— «<M 






oooco 
CO t^. 












CM 


CO 


00 ^H^H 






COCM H^Jt 1-4 i- 4 




CO 




00 1-4 






W5N 






e* 




CO CM 
CO'-' 






















CM 


T-H 


















00 








»-*<M 








00 CM 








CO 


CO 


IM 






rH t^. T-l l-I ^J CM 


^t* 




i-l CO 
























Oi CX 






















CN 






















CC 








cs 















■eOlfl«HN^U5©C<liHrtiHN^iNNeO^«HINlOW«0 
1 *H (M CO W5 W »ft <-H 



JiHMHHONWlO 



^ 2- 






! -J3 O 



a-sja 



s -e .— .— .2 
-a so " 

C. re 



5'S 

ja'Sb'S'-S 
b n. co " o 
o o > g>£ 
o o p S^ 



a :.e» 



>>S-P. 



.;•« 



•pg-e a 






> a 



•*» o 
2 ° 

§a 



a aa 



£ a 



>> D. 



sa. 



-a ^J-] cS2 
° £ o.-g o"S 
a ac ac a 



o o 

„ ■OT3 

a c c 



-~'3.2 b t: b'b'b o a 



co a 

J3 O 



5 o o o m a 

3 o o §£ 3 lg.-Slo-3-rt-co i-gg-g^^S^-J § s " II 



cat:*; 
m o o 

OT3T3 

: >> c co 



>.g<~ CO o g g 

o 3 £j2 J3ah 
a) a) ja cuJa M oj5 

o"o o'o'o.g g"^ 

Soooo»oS 

a a a a a »3 s 

ri C<3 cti A cJtZ-u O 

SCJ Cl G G C t<_ t«_ i*_, 



a c a c a c 

o 6 06 6o 



uo 



74 



5S < 









3 

eg 






■*r CO 










C-J 




CI 






































5j 


w>oo 

i-f CO 




>o 






-r ,_, ,-hco 




CO «*co »o 






s 






"3 a 


*<* ^oo 


CNr-l 




CO O 




^ 






CO 








« 00 








i 
1 


H 

?. 

O 
N 

Z 


g 
DQ 
O 

E 

o 
-< 
Cm 


Army and 
Navy (offi- 
cers and 
enlisted 
men) 




CO 








rH -^ 
















tO«rt 








.-KM 


0, 

S 

o 


>> 

a 

<% 
s& 
11 

M 

Ex] 


O 


»H<N© 








^t* 




















<o 




** 9 




OQ 

o 


e 

eS 

1 




ost^ 




ie 


O* o 






CO-H^H 




O Tf 










< 


Q 

u 

z 
3 
< 


Army and 
Navy (offi- 
cers and 
enlisted 
men) 




r^ 










co-^ 










^H O "*««^ 


















>> 
8 

-o -a 

K 

H 


6 


CO 00 CO 










CO 


i-HOq 






<M 










" 








S 

i 




OOTflH 










"* 






CO CO 








CO ft 
















"3 

o 
H 




" 


to t- 














ffT 














CO 










CO 






«e 





I 0* 



-§ g.a a 

■s|| 

■S g-S_ 



^— -= s 



a -I 



•i| 

la 

■s£ 

o 
C 2 
.2'3 



J "3 » pc.2' 



5.S a « 5 B 
o a fl S c .3 
-3 to ^ 






r*0 b 3.S 



o. o. K cj tv 

a g >-5s 

ffiaSco 



<<2q 



1° Is 

S « O QJ3.^ 



O O-O ft t, " 

! 8 s'S'Sj" 



"3 = g g a rt-f-a S 



• ftso 
S.S2 



75 





















•*- 








<M 




N 




N»*- 








ON 










V c 












CO 






^r W 










ua 


(.JrtfHiHNNCCN'-lrHGO 
1-HIM i-t 




cocm 


— ^1 CM t-« 




*o 


o 

CI 




NiflNrtO 

»o 






0*0 


CO 


«-H CO 




«H(N»Oi-*MM(N-*'* 




CO 


— 


CM lOCC 


(M ^h ■**. 


» 






CO "5 


»-i CO 


— .io-«* 














(N (N (N fh N i-( H i-HO 




■f 




Tf 


rt 


CO OiQC <-h 

FH '"SI 












CO>-i 


■^ 






OtfJN^ 






<N 






lOCO>-H 


(NHHIM 


T-.-^ 


O5C0OCN ^ OS 






CM 


Oi*-i 


>-t CM CO CN »0 

CO 






o 














eo 








*oeM 






CM OO 








O00H 






CM 


CO 


Tj<C^CO 




GO 
■M 




GO CM 
















CM CM 1-1 Tt* Tf< —I 

CM i-H 




CM 




CO 


.-h Oi 


Nm 




N-N-(M 
CM<N 






■^ 








CO*H 






O—" »o 
CO 






Tf HH 


--HpHNrtMMNiHHrt 


T* 




CO 


OWN 


C*'1 1-H-H 

CO 


"OW-MH 




CO 


hhO 






« 










« 
















o 






u- 


o 


CO 


cs 




COCOi- 








**l 


CO 








CO 


S 






"•O — 









iOTTi^O^(N'HCOCO>OC31NO(NN^iHNMOfO'-iai05COCTi | »N 
CM «— i (M 00 i— i CO i— « .— i -^ CO i— 'CM TpCOCM N-^f^^ 



JtNO^^OOM^OtNMCTi-HnOH 




76 



(M ^f (M <o N 



■»*> co*-i e$ e 



. ^ OS *-• CC N 



.t^ o 



— 1 -*f1 1-1 



a >%'■% a 



■MtOlHtHfH 



kO »C ~* C-J <-H 

00<M ^^ 



-h CO 



.oqqo-h -m 



•TJUC^-'Ol 



!*s 






a 






■ N *-H •■-• 



CO CO CO NO 00 



OO'— iN^Ji it} tO *** 



CO»C CO<M 



O W MM N 



3 



« a*! 
g*^o 



» ° S-- 

co -.52 m o £ 

m-S.ti S c « 

B"9 



=9.2 ' 



•3 ca-S 



'Is 



M 



t. a. a. m S 



i S SJa. o 



o o TO 

IBS: 



3a 3ga = 



OS« — l-*-H — 



1J § 



a az-S 

goo" 

g >v C 60 



re o 

.5 a 

•Is 



:a.S 



*>2~ a 1 



j^)wm.«w M oooo ct--^ * S a u - 9-a5- b ^ 5 w - 

OhMOSW QQQpapqpQ03U JUhPhW^PmOO^^O OOflt 



77 



o»©*-« 






CM CO 


CM-* 






OOOCDMCO 


o — 






cot* 


—• CMCM 








cm 




(NMifl-H 








CM 






oo ^ »o -* cm 

CO CM 


— 


cmn 


Oir~t-»CM^<Tf»OOCO 
COM — CO 




CO 




O CO 
CM — 






^ ^ CM GO O 


O^CMOOOOCOCOiOCOCOO 
rH "Nrt CO CM 


«-« ■— o CO *o coo 




r-H CO 


i-H CM CM O CM -**« 


CM CM 




CM»0 




t-i N N CI W O 

CM 1-4 


OS — 


COOOOO ■ 

•^ OC CO CM • 


-** 


^CMiO 








— n 


r-1 HTpHOJtOWN 






OScO'-t'-iTj'CO'— "»-HC0*O 


N<H<NiOCOtDN.CHNO'HH^»H»M«^ f-4 »-« CM *-< i-" CO 




^-tesicococo 


CMCO-H • 


NCM — 


Tf—«— lO»Ot s - , f r OCOb»'— < 
»-< i-H CM CM CM -H 


CO CM CI 


COO 


N CMCO 




o 


CM iHIOi-IWlM^HH 




(MO 

co — 




i-i-if »OCON 


CO 




*}i CO CO SO • CM «-h 
(NiO'-' CM 






Tfi 










coco 








»o 






•O 


ON 


**i»-<i-«icot>.cocfcCM<'* , c»co<-« 






cm *r co cm 


CM CM 


-H ~H CM Oi CO «o 








•O CO 

CO 


>-< CO — 1-- — CM CO 


o>cm 


COOO<h ■ 


-V — 




-T'-h-i ^iOhhhcO 






!>.!>. 


r-»CM*-H 







N^'i-iO»OiCOMNO>'HfHO>00--<c£i»00«>0-* r £iOiCCOOXiO 
COcOrtiHfHMNHQOTj< 00C-)^O»C>H00fHHiOf-( H lO CM 



»-t 00 N CO Oi rj< c 



OCO^fOiOCOO'-iCMT-t 
^-iiOOOCOCOr-tCM'-t 



CO CO 03 CM O 00 



CO — »0 CO 



CM • — CMOOSiO — .^;o— — 



«-H CM 



ON tO CO CM 

MHfHCO 



CM CM — CO 



— CM^ — 



— CM O OS CM CM CO ^ 



-go a 

£ 3-3 



4> o g g 

2 C3CM-T-J 



a c s 

o 3 .2cm 



« M 1 rt 



-cn-o 



g <=> 



T3 T3 
— tS 






8 "3.2 



o<„ gJJ.tS 



S'C a ■ - 



S o'S-° I 



,_-a 2 
3 '-3 






§,'5-° = o.a-S^' 

g <u _| -C g is 5 ° 

S5S, 

«2 O O. 

:t3 a. 



31 



;2 Oj'f 



.2.2 o.g-S,5_e § g_g g^ 2-S « SKfe-S^^S 5J§'° ; a.a' a s 



1 3 «j 






78 













. CO 


coco 


rH M ■ 


•CO>-l • • 


H ;*m 


rt 


n 




^« : 




C) 












a "° 
























.2 -a 
























Z'S 
























£ 




























CO OOOH VC-JNtOO^N 


• <n ^j« co r^ 


CO 


OS -^ '■£> 


•t~ <M 


JON 








"o a 




CM CO C*»-i 


CM fH 




CM 












&i 






















srt tS 






















0(2 


























CM r— COOS -H ■ 


COCD00 • 


h — CO i© T* 


CO 


OU3t>-< 


^ • w 


• 00 CD 












co rH • 








N 




CM 








>>-§ 
























-^ O 
























o^> 
























"gSg-a^ 


CO CO • 




PH 


























§3g S -g 
























































s 






9 > £"3 " 


























c 

3, 

S 




e 

03 


«3 ca g a> 






























CO CO O OS • • 


■^ ^ -^ • 


CM ^ OS ^J< CO 


CO 


•^ -H CO 


• d ^^!0» 






>, 


E 


r-| rH 


1-1 


rH rH 




rt 




M 




o 


a 


_c 














'•3 




~ 


<? 


O 














_3 




Ph 


f! 
















- 
























T3-T3 


a 

C3 


T* iOlOlO ¥H ■ 


C<I U5U3 - 


rH OSrH 


o 


•«!< 


CO • • 




■CM CO 








.3 c 


















GO 






^3 <s 




















a 


























CO 

«i 
O 


g 
o 

►a 
•< 
z 




W 


l 


















i-3 




111 


3 -u> C 


rH ■<** ■ 


























O 


a 


1*1 

JS « c 


fl S 


































CO t- CO CO rH rH CM IfD LO ■ 


■ CM CM CO C^ 




NNrH 




•COCO 






□Q 






















o 


>> 




















< 


a 


O 


















j 


** « 






















bpi7 

s 






































-3-o 


□ 


rH CO'-'^ »H 


CO»-H -^ ■ 


•U5NH CM 




Id C^ 














3 c 


























~ a 




















































W 


a 


























< 




























CO CO »- ' t— OScOCCCSlt^-i— ttMW5COt s »'^ us 


C^ 


IM CO 35 CO OS -^ r-i y5 0C 












CM UJiO^ i-t CM t» CO P3Q0CN CO 




Ot-ii-H Wfl' 








































o 
















H 






















OO lO^HCO 


<m : 




























































4 


























































































B 

a 




P 


3 


























^ ► 
































: - 






















































c~Z 








CO £- CM i-l 




•HlHtN 


CO 
















~ 






























W 




* 


£ 




































-o • 








; m 




■ ^ • ^ 


• * o • 




















C3 ! 


• c • 












■ T3 • • 8 






















; c3 • 








■13 


tt 


■ 3 • _; S 


• a> * 


















■8 
J 

a 

o 

p 

1 


■o : 
S : 

Q. ■ 

"o • 

c ; 


. . 3 . 

■'o ■ 




• • ■ . 


3"S. a 
3 S " 

> OJ g 

ail 




■o :5 = 
: -S -.It 

: o '.-c 

:S :§-S 
:-J :.j-S 


: • 3 : 
:-o ■ 

; • 3 ; 

■ :«a • 
: ; c. : 


a 
5 

a 
i5 

ri 
S 
















J 


§ ' 


• : S ■ 




: : * g g> 


-a 
s 


: § -J-s 


•■§ ' 


3 
















a 


ho ; 


' ° CO 




! '.'B"~' c 


; o 


: ° : o o 


■ : c • 


13 c3 










5 




a 

.s 

3 
cs 


o ; 

"3 '■ 


'•— a ■ 
: us " • 




' : fc*^ £'5 

■ • C. Oj « 

: : o <d ~~ 

■ ■ 3 2-° — 


• -a 


;.2 ■ c"" 

•■& :.2"3 
9 S :"35 


: : 1 : 

. . C3 . 

: :| : 

• M & ■ 


s'l 

•si 

a"2 i 


s 
1 












s 


■a : 

a : 

'o ■ 

S_ - < 

8 £- 

•1 


:j= g ■ 

:-?J •: 

»T3 m .3 

: c Si 

3.2 1 a j 
S'3. S 




: :g^o| 


1 # ' 


2 o . 3 g 
| 1 |'gj 

35«d C 

a p 1 m'E 

3 O g O c« 

3 o Sj= 


- «H 3 • 


» S a 
^ f a 












<3 1 


■ : • ■> 

• I - ■ o 

• s ' • S 


■ : C 3 tnt£ 

• '^TT ^ m a> 

• : S5 s?5 
: g_g^. S«h 

•a | l"e 1- 

■<~ g cj S a 
: °,S w G » I 
a S id 1 ? «'-5 I 

g g-.S J; i. ^ : 


K 

e 
s . 

i S 


iS^ : 

§1 
: j3 § : 

.5 "^s : 
> fc a q 

£ £•§ o 
a o its 

■g °-fex 

o J; a c3 

^5 3 


° 2 a 

[§£ 

lis 

S"c1 S 

III 

a a j. 

lis 












P 


o c 


iccO H 


qQOWa;, 


4mPC 








fl^J BC 


PnCfe 


ShC 


hC 


) 



79 

















iM CM (M 
CM 






°* ; 


















CO 










CO 




C) 
















CI os c© cm 


,-1 -^ 


00 • 






,-1 CM OSi-i - 


c* • 


t^-CO CO • 


r- 




COiO OSCM CO 
CM 


OS ■<**-< CM 


CM CO CM Tf iC<M 


to O CO 




tOi-i 




t-» CO CO 




CO i-i OS 


CO--t OS i-i 


CM t>- »0 
CM 


•*-H« 




CM 
















cocm oo 
coco 




i-H CM 






CO *-• M« 
CM 


CM CO »-< CO "<t* "* 


o 






CO T-t 
















_ _l <*Ji CO CM t— I NON 




"* 






rHW » CM 




t-t-. CM 


CO iH 


^ 


00 


CO 








<N CO CD CO 




OS CO^H 
i-i^CM 




cm 


MHiO"* O i-H 






COW CO 


O 




-H«5 




CM^t-CM 


















1-H CM 


cm 


CM 


tHI/5 (N CM 
CM CO 


•^HtO 


CO CO t*- 


TtH 




o 


















cm 






CM 




CM 








CO CM ■** 






«D iO NMO 






O i-H i-H i-H i-l i-l 

o 












if 


> 


C 




t*- iO =c 






03 




r- 




CO O CO 






C\ 


t-(CO ■* 


^ 






CM 













PlffiO OiOJO- 



^NNCOrHOCONmOlO 



CN| ~H »0 O ■<* ■* ~H Tt* •"* CD 

CO CM -^ CO -^ -^ 



(M t-t OOi-h 



I>.COCO-«3<aOCOT-HTJ* 



CO ti CNJ CM 



~- CO »-* 



0, > 



? = 



•-j 



'J |§1 

I "8 3 — 



^J3 



. 2 °ll3 

■ s.S | § §7? £ 



J 2.i 



.» J3 3.2 
Q C3 C3 O 

.2 S-9 

s2'E 



1*8" 



1 IJll 

I s a s a 

- S jqf a § 



O 9 



a «g 

OS 

/33 



xj '-3 o ^ -5 



—■3 






M"2 



)M 3 
> 3 t> 



•3-R-3 ° < 


5 '2 g 3 « a « °:g 


big t«S 

a.H 3 j 


J a 1 1 ^ M i & 


OSOO 


Soci^^o 



80 



— « • -»to »on 



o a 



■r-nMH© 



•^<.-<(M.>0 



o a 
2io 



«t»«n"<o 



■ r~ e* t~oo- 



•CM »-• r-4 H 



■o eo »om«f n 



•co *•« -«fOco»-« •CM^eowa 



HZ 
■g-rs 



NXN • -* - CO CO 0> 



j'S-o^ 



■ <© C^ C3 •«* ■ -1 



<M.r--H— < 



-H 00 11 CO 






^H -J -^ -— IO CS CO -hcOCMOO 



O c 

3-2 



^S9 



s g-s:§ 



rtH^H^W 



-" Q-a 0.-0 
d o o 9 g 
— c t*.S 



&a 



a<a 
o 
'•3 >> 



oa r~ -* ci ■ rn -x) ro oo 



. w ^ ^ ^, 



2 "§3 g 

>, a. >> >> 

I £ II 
a. s a 1 1 



1 



c c 

GG CO 



o u aj a 
3 O.'S.'S 



a 8 &c'c S"5 g g c g.j: 

ca "O "O VO* — TITJ'C ^ 



s-o-^ a- 



a 



So 



a'" a 



II: 



81 



00<MCC^ 



-H 0*»-l 



t-1 OiOJOJ 



CO COrHiHHiHCDNOOM 

CO C* iH <0 



(NOJO'VH 



oao)H 
»-h r- co so 



■S-5 



•1T3.3 



5"° 



E a 

&S H i. 

si'iilijl 

.2-— -a aoatiu 
w m 2 ^-^ ^""w 
ggOoj»- t, 2o 
•ot; J; 2 feu § o 



■& 






MR 35955— 6 



c » g 

a e g 

|§ = 

: <f. fc"° 
;"° S"S 

3^ a °o 

mil 



g ^2 g 

UBOS 
O O V o 



82 















o 


COMCMCCW5W 






CO to 




M CD 






• •** to CO CO CO 


CO 




c^ 




. {DN to 












o 


i^fHMVMto^F- • 


C-^ CS IO »— — • 




•kCC-S. »- — ' ^H ~< 




■ CM f- OS 










«ra 


OOO—'OOOO • 


cooooo 




■ IQCO OO O 


S ■ 


■OOO 










t^r 




















t-* 


















o pu § 


























o 


CO 




CO 








tooicoeo ■ 


o: os 


■ CMOS 








CO 


CO 


. to toco 






ft*. 8 




o 


CO 












CD OS CO CO • 


OS OS 


■ COOS 








ro 


- 


. to to CO 








o 






CO 








o»ooo • 


OO 


•t^ O 








O 


e 


•OOJOO 












































s°a 




o 






































CO 








































-O^ 


OO 








lO lO 




ifl Oi« - 


















IQ 




;^_, 
















OiOS 




CiNOOO) ■ 


















o; 




■XC1N 








Tj|g 


•-J 








*"1*1 




t-1 CO -^J* CO f-H ■ 








• r~ 














■NU5M 








S^ a 


•« 




















■ CO 














CO ^H 






s 




° 








































































Q 












OO 


OOOrtU) CO 










o 


CO 






CM • 








OQ 






CM 


to 




a 


a ^ oo -v wo a) 






■ o 




GO 








00 


NO 


>. 




>) 


cs 








T 


THCOOiNN^HO 






- OO 




o 








o 


coco 


a 




O 


> 


(M 








',H ' tj« 






\ ^ 














' ^ 


a 






bO ^ 


































£ 




Q 


.9 Si 


o 
































CD 




2 


"H-o 

.3 a 


































u 






































O CS 




«5 


CM 








■^ <r^ 


■ •& 








CI 


















«s 






>ra 




hiOOhicO© 


■^ ■ 


^H io 










"5 










o 


j3 






"g 5 


«5 


""! 




Oc^cOOS'^CC'-i 


o 


OS-H 


■ OS 


















to 


G 


B 

55 

c 




■5 


a 1 


to 






t^ 


CO • 
























DO 












































































DC 

c 

►J 








"S — 


<M 




























o 
















• U3 




7. 




5 c Sea 


t- 








ffi 








"•*< O 










X 


















■ CO o 




-1 




•oSc 


OS 
















CO CO 












• to 
















• coo 




h3 


























































<« 




a 
















































g 












































t» 






u: 


















t^ 


■ -^t 








r- -^ 






■^ 


















oos 






C5 «C C3 Oi 




OS 


• t^ 








OS OS 


cr 




OO to 






o 


>> 




cc 








^o 






hNOO 




a 


■ r- 








O ~H 


c; 




•^ o 






z 


> 




c 








































.9 Si 


6 










































-i 


.2 a 

73 =3 












































«! 




_ 












o 






o 












od 








o 








r^ >i 




w: 








ooo 




rtiCCO 






■^ 




• -^ft 








-* -* 








-K 








H 9 




QC 








Tp^H 




»oo^r 






U3 




■OJ 








>0"5 








lO 








<i 


s | 










cOC3 




i—to 










•CO 




























to tc 




to 










o 


MtOOSONCOO^ CDO©tJ(M(C 


tOCOOCOCOto ocotcc 


to OOO CM 












t*- O C-1 O "O X TO Ml- — — ooacoc 


om^m^o f moc 


oco^as 










lO 


OOO'^OOw—.^OO'-iOOOC 


OOSOOOO oooc 


OO CO 00 






o 




a 


CM 










H 




s 
















TK 






O CO 








to CO to 


OO 






OO 












:•* 










CC 






-«co 








a^co^ 


o 




- to 


O 












- CI O CM 






*2 










<M Tf 








COCO-f-M 






• o 














• coco»o 


m 




— 




OS 














CO 






• ci 














*-i in 






« 








































>. t~ 












































O -5 








































J z 






















































r~ 














*o 


mic? 






















»o 








ao 








OS 






C5CJO 


os trs r~ 




' I>- 


















OSOO 




.■§ 












IC 






(NON 


M(NN 




o 


















CM —• 
























Cvl 






























s 






























































































■B 


































































■ p 


































































: a 


































































o 








































































































































































































































































. ^: 


































































:| 
































































:s 








































































































T3 














>. 




■"C— - 










































tl= 














to 




: c.3 
























1 






























5 

O 




. K O 


















as 




c 

E 

C 
P- 


■3 

a 
















li 

■ o 

J I 




3 

.- 


a 
a 


• • 1 


-3 C 

rt o 

s 1 1 


• CO 

:J a 

■ o .g 


: i 


j 
















o 
















ci'p. 

ib 

° o 
o.h 




O 


a 

3 j 


; <n | c-g a. 2 a, >> 




I ; 




























;.| 




3 
-a 

o 


3 • o S S- >-9 x.S «; c 

i : l.I|-§aP , -3ill 

s ■ S 1 c I'S _J £ ?.£ 

f ^oooo .■§ s o'° T 
3 -ooooooo-odc 


f ; 

1 ; 
















4 














■ 1st 

■ Sg 1 * 4 e 


: - 




9 t 

1 : 


: 


i- 














i 




: | 


D 

- £ 
-— 




-c 
' tc 

3 
. g 
- bo-5 


• %ss a § s 


SI 


> • >> C3 

i - i"§ s 

r : a s- 3 

3 .'ESS 

) • C. to -^> 
















n 
| 


i : 
u 
_ c 
•> - 
if- 


ij 


•j 


J : 
3 C 

2 c 

1'S 


^ - 


5 S 


j 


- 

1 


1 
i 








7 

> ( 

t 

* 


j - 


i2 j 




- J 

-t- 


i ; 


^ J. 


ls-1 

3 3 


J 


IJ 

'-L : 


■1 

•- 
1 ; 


!fe.a 

i5a 


'i 

1 '- 

V 




1 

1 



83 





o o 




QC X 

5* © 




~ *0 CM CM 

oooo 


















o CO co 

I^- — CM 

CM o o 










CO TO 




c 


CM CO CO O CO CO co 
lO -^ i— ' OS i-< i— i CM 
O^HOOOOO 




CO 

CM 






l-O 

CO 

O 


CO CO 
I— CM 
OO 


CO CO CO 

co co co 

OOCO 


CO CO 
CMO© 


CO COOS 

~o© 


CO coos 

CO CO CO OS 
OVNO 


CO 

© 








OS CO CO 

ooo 


ro 
cm 








OS 

OS 

o 


OS CO 
OS CO 
i— CM 








OS CO CM CO 

OS CO CO CO 
©©!>.© 


CO 
CO 
CM 






o 

OB 
CO 


Ot-- CO CD 


■n 

— 


a: 

CO 






»0 
CM -»< CS 




uo 

93 






at 

CO 




io 

OS 












"0 










MS 










CO 




en 






OOCM 
thOOQO 

oooco 


CM 

o 


CON 

CO go 






coos 

TfCM 

lOCM 














■^ CM CO GO »0 












CO CM 

-*»o 


CO CM COCO 
CO OO CO CO 
l^O^H — . 


00 

33 




CM 


o ■ 






CO 

I- 


Ob 






CM*-** 

•OO 






G© CO «0 
1>- CO *■»< 












o 

CO 




CM CM 

CM i-i i-i 




CM 

»o 


r*- -<f CM OS CM CM 

•COiOOiQiO 

Tf CO — 1 CO 1-H 1-H 




CM 

CM 




CM 

CM to 

CM i-H 


CM 






CM 

© 


*o 

CO CO 
lOCQ 






*o 

CO 


■3 


coo 
oo 

CO CM 


IN- 

CD 














r- io 

1-H CO 






M 
CO 


OO ^H 










CO CO 








-** 

CO 






,290 
.097 
.968 
.097 
2.13 


as os i>- as 

00-00 






COOO 
OOCM 






os os 
oo 


oo 

»o 


o 

33 
?! 


C3 


OS OS 

oo 




t^. r* r-, i^. t^. -rt* 

OS t^ OS OS oc cs 
O CO OO CO i-H 


BO 

CO 


CO 


r-o 

OS OS 
O CM 




I*- 

as 

c 










c 
■■>: — 
















CO CO 

00 GO 






















= 














e 








CM 

CO 






CO 




Jr* 







> CO CD CO CO 



(^DCOCDi-HCOCOCO^PCOCOCOe 
' O —< O C " 

oor^ooooo»-H.ooooootoooooooo: 






^W^NiflVMINQOCC'MOwMt 



<ooo-oxijii.oMioorHm«o 

— -SO^hOcOOOOO^h 



■<M<OCOCOOI>.sOi-HCDCDrticOCOC 

• QrirtiCTf^ocjoomwHco 

■ti-<Oi-iOOOOiOOOCOOOO 



Ol ~H 

CO CM 



•O T* O 
OOCO 



Pi 



III Hi's J 

~ 3 3 O O > g<» 

"O'o'oX'S'3 S"" 
Eooooo&cg 



03 



a -a 

-9 e 



26 



----- o 



.5.2.2.2-5-9 

aasi « c o o c eja n §-p — — — — -= S - e ,u .*T?.Sja.K 
mmOUOcooch,(i,k2SSS2B/>o^KocoC!SS>o 



5? S? S g 1 > 

9 a c j- m .ss 
9. >■£. fc «■£ §| S'S 



-^ ff"Pt 



O O O Q O O 

a s a a a a | .§«§ S = s IS 

ls^:'^:u=;^:S m m w m B"3Ci.9 

gllggglili I r-I g 

oooooocasacj;^:^ 

3— ,._ ,___,__ rt rt rt rt rt w- *a o 
"t3T!-Cl-C^JT3 c a G C DtMh.h. 

aaccccctcbD&ObObcooo 
j rt n s n a s^:^:^^:^ 

caccBcgggggaaa 



84 



■5"^ a * 

.-. o a g 

O &< a 









'flifltOO 



3 s 



NlNMONiOOVOO 
O^iOOOOOOr-^C^ 



<S :0 O O ;C CO 

oooooo 



NiQOOOOJINO 
<M©-^©0©tTO 



si 



|a 



■ it! ! 



a-2 

2 — S.S 



*».2 a 

o a a 

Mj= g- 



I- 



S-a.2^ H a g±>35 



b.2 53 g-3 



■ a S O M 

!■§ c'S."S o g o 
a-2 «j5_£ 



: 2 b 
"2 



£'b 

\2'o 

•a fr 
>.2 



■•a o oj3 a 



O O J3 O. , 

2 a^-a 



85 

















CO CO CO OS CM CO 


rtio© 




■lO ■ 


CO 


• CO «5 O CO CO ■ 


































oo 


O 


■OOO'-'COOCMOOO'-' 


._o 




hOhhOOWhO 


O ■ 






■OOOOcO • 














OSCOOcOcoOSOStOCOCO 






OiCi 


■ cococo • 






OS CO 














OlMCOCfCOOJCMM 




OS CO CO CO CO co 




















o 


c _ 




ooo*-oooo — <^h 


• *-' 








' _i 






roo 


■o-v 












































cm 




■ CO 


O iO 


■wa 


-iC 


CO 






CI 
















OSCS-chO CI OSOSOsr-- 














•OS 






coos 


















C*—* CO — 






CO 


CM 


coos 






iO 




ITS'— 






OS 

d 
















MtN 






CO iO GO CO «D 












CO 














o^co 


co oc 






CO Tf O CO -^ CO 








• CO CD Tp CO CD 








CO*-H 


IQ 




o 


o 


^ CM O 


— O 


o*-> 


OCO 


NN ^-H1HN 


•o 




r- C 


• O-HtNiHCO 
CM 












IN 
















rt 




^ 






















fN 


























ID CO 




oco 








iMTf<ir 








00»0 
























^ 








t>- CO 




CO CM 








fHCN 






OS 


CO CO Tt* 




CM 




CM 




r ^ 






























^ 






t-r- ■ 
















rt W CI N ^f o 






■o 


CO^H 






CI CI c 




• o 


•J 




OcO 


COCO • 
















CO CO *0 CO CO f-H 
CO CM 




co 


•*o 


1-H 1Q 


COiO 






■ 


-co 






>OH 






o 










NN'J'NOO'J'NNN 






^ 


-H ^ (-^ 








ts 




r—l^l>. 


i-- r* co 
































OS OS CO 


oo 






oo 


O O —i O CI CI " o o c 


■ CO 




iO 


iO«tO 


OS CO c 
CM 


oo 




©C 




000^-4 
CO 


O O OS 
















oo 


o 




■ o 










> 














■O 














CI 


^Tjl 












oo 
















tt* 










■~ .r 


• 




CO 


io>o 


iO 




■ »o 


t>- rti 




o 


to cow 


) 


■ 1— • 


CO 








Oi 


































CM 




o 


>o 








• ^■^ 




•CM 












■ >0 




TO 



CDOWmOaONOOtOTPNcoNOcoeNKO^OrfH^CONOO 

O , 5M«cCOTp-OZ>'t»-'3iNMWT}iO(»mOO'-<30«WS'OC31>O0JC000 
OOOO-HOONOHiOwtHOHNOONOOXONNHOHOlO 



MMCDNCOCOO'OOMNCD COCOO 
'-h CO O CO i-i CO CI CI Tf CO ^ CM t"- CI r-H CI C 

OOOi— lO-^OOO^^HOCOOOOC 



CO CO CO CO CO CO CO 

UJOHOHrtH 

t^_ _i CM »-» CI CM CJ 



t^ CO 
rl CM 



CO oo O »o CO CO 

OOC'OIOOCOCNOICO- 1 
-hOi-i'sDCOOcONCOcM 



1-1 T-l 1— I CO 



CO CO CO CD cococo 

OhcohNhOON 

r-lC-l^CNfClM'HrtXi 



- |J& ra 
a.23 a--^ 3 * 






o o £d ^ 
o o-a 

§ a o cd 



&a 



£"3 £s_o 



-co_;w"hofaac3 

fll 1 3 a;* & fa fa s fe-S * 



.2 rt 



„ i'3 cS <w a*a cp ^ > S'S ? £ ■** ^ fa <D 

s g £5 s Si §3 s ija : ag s s §.§ &J s^ 



g a 



o g"C 
o rt S 



C3 > 






■OS'S 

•5 Brs 

» Bo' 



r3 



■So. 

IS 



a g 

■o o 

c >. 



ggs-gj 



o o. 



.ts -a -a -a -^3^5 " 

^ t9 C3 rt >J >J-S 

g o o o § g 53 



O H 



O^^ h jj g ; a g » 

a) o rt-o di; ^; d u o 
0.01 a c g u g g^^ 
ts K.2 « >>o S^-3 S 
•9itS!3 3'gSi.£53§ 

tsD^ Pjp U^ C"5„p CJ 
P-— 3+j P ^ rt R-*^^ 



°„ d a 



86 



■ GO CO i-H CD 



■ CT> CO *0 CO CO CD 

■(NOlNO-HO 






J05r-rHH 



■ CO^h 10 



OJ CO CO 

■^ DO CO CD CO 



• CO *=t« O) 01 



OS OS CM 

• »C CO CO CO «— i CO 



5 rt 5z;<i*^ b 



• oo 



■ QOCKJ i-f 



^ 3 



^ CO 'rf O CI C) iC "- CO iO 

*-<©oooocoo»oo 



■OJONih 



uoooooc^ o-tociooc'ic'iMo^aoN 
aooconOMOtowoooooMO 



•J3 O ° 

d a^s g 

O O m 

£■8.113 



a 



ta- 



il CT) 



.2 n 



32.53 



s aj &a 



a rt_2. 

o <U O) ' 






. t- o c 
S-.3 O 



asaSccc=a3i:a3a»oS 
.1.2.2 S £ 2 S §"§ s _§ £ ~"3 o-t? 



S c 
IS 

0,0 



87 



JOOlMCSOOOJ ■ i-H 
QOOtO-- "CM • ^ '«)C» .HCROlHOCOOiM -i^- 
NMOOO • *-« ■ »-h O 'HOOVMh^O -CO 



• CO CO CD tD CO CO 

■ooo-^oo 



OJNMOJ'OO 



■ CO CO CM CM CO CM 



'HOIWO ■rtrHiCMOiiO 



O ^h o o © >** 



■©©©CM^H© 



• M M O O O 

• CO CO o co CO 



'COCO^COOOO'-DOtDtD 
- H O OS CO CM CM ^H CM oo ^ 



_ ?co © osco 

• CO CO © OS CO 
■ ©©CO © « 



• CO CQ CO CO © CO 

• CO to CO CO © CO 
■ © Q © CO -^ ^ 



• OS CO CO OJ OJ kO 

• i— i CO CO CO **P OS 



. — , _ r^. i— i »o •- • 



CM CM h- lO CS CI OO 

•^©OOOOCM^OsOOcO© 
*OCO©OCOCMOO©©^f 



_ x o 't co a 05 c co >o z oo oo oo :o -r cm 

■rtO-HOO-*COiH^xfOOOOO(NM 

CM <-< »-• CM 



CM CM CO CM CM 



© i— " IC >— ' © CO CO 



MN H CM 

■ eoicnocococoiocooono 

■«HHH(NNO I OOHO«)H 



• © iO :C JC © o 

• CO •— ' CM CO CO CO 



• t- t-©t^CM 

•tOONMON 

•FHrtCOOOkO-H 



■hhNO 

• ©I— »-.© 

•■^ OS CM ^H 



rHOOOOri 



^OSOS-^t^-OS'TfOSOO'^OSOS 



■ *-- t-- t* i— I © tJi 

■ OS OS OS O. OS oo 

• ©© t-h OO CM Tf« 



• iO CO U3 t- iO O f X> 
.-H CO Hrt 



CM © 



©© 

. O -^ 'Tf 



© t^- O *0 no © 



iM^DOOOOMrH 
1NCOOO'- 



- O "- ' © t~*- © lO lO CO CO 
r- jo CM © co-^CMOSt-r^co©© 

OiflMOOHiicOONNrtfH 



NMOONOS^OCOCOiOCO 

■" ©©©©co ©^ 



© "^ CO © © ©©CO^^©© 

V IO ^t ■fl' O O M tf C »0 CO CO © 
*--CM©©©wO©©COOCMCM 



COCO 



if 






_£3 M £ £ 

"3 C3.J2 5 

ooQo 



■OrH-HOMMOHfMrt 



" S"3 

Is § 



1*3 1^ OS CO 



rt"3 _ •p 
a c c >> 

I 3-2 £J 



J. a | 
QQra 









= 9" 

"° a"- ra 
S a g-J: 



-2 c c.2'J3'-3 



1 -«3-a 
1.9 c §a 



OS OS OS OS 



JH^NOOJ 



■ OS C*s CO O OS OS 
• CM iO "^ CO tO iO 



■g S ">-n 
<s"c3.a.2 



■a-c ~ 
•c-2 3 



<50t5pO<i!0-<OOfla«!KH«00<iOa500fc 



P, C m'C -O 

a> >, >, >>.>>_ t3 rt 



3 a, 



03 



IKS: 






■§."•* l^^l I 
<ozivi£(CBSooQgo 



88 



^H»HW^ 



■oi«ooNN^ow5a«to 

•MO>OQOWNOSP3N'-"N 
■O^CMt^OOOeO-H©© 



o « a 



•COOWOO'-O 
■ O O M (M « P3 



■WOMOUD 



os co co eo so 

OS CD CO CO CO 
OCDiHNO 






• co cm »ocm co 

■<-ip:>ccoo 



»0 NU5 



MNCIO 



2'^ 

3 =3 






a o8 



- OS HHH (T3 



• oor^-co^foscscsccco 



- fH ft O CO 



• COrxO© 



- TT CM •*** CO rp 
•l'JCD»0'-'»0 



ss 



■ t^ t*- us O 

- C3 CO ~H 



NMMCOOM^J'CNNON'HNOMWO'-tO^' 

*"Gccsjc^iooao-«po~*c3<Maocoeo 



QOMN-toNiO- 
0--i OOO-h roc 



NHShOOOBCl 
v: -c s r ■ c ; -.o <m o t-» 
0«0000>-i 



■ o^ooonon 

■T-H«D^H-HCX)CO^HCO 



.2 J3 - 
'a'o 



C3 Jr> 



<u ° C 



£ a 

llSJl >Jit'-f J! 



3 -a O bDT3 



a) Sfi-e ^S 

§*■ £"S -g 



3 C 

"3 °' 
c'-S 



•2^ a 

^ 9 3 C3 



• Sen -75 



g.o o a 






-e5cS-3ai 


s 


o a> a> q, a> 


j 










£.2:5 o5 





cf ^D," 3 

■21s " § 
b c3 "o <a 

U f B 

4 9 > B D.-SJ3 

*S C3 3 « 2 S 
i in g i. a o, a 
? ^ g J: p 1 3 



89 



















■CO 










coco 








O OiCTS 


OS 




■ cieo 


CO «OCO 




CO CN CO CO 








































CT 






c 


*-«OC 


rt^OOO 




o 




©*-t 


^o 




o 


ooo 


a 




;OCO 


«0-H 










CO 




OS 






OJCOO 




■ too 


CO 


COCOOi 




CD 






























CO ooo oo^c 


iomo 


•^hO 




<M-«t« 






OOCO 


OOCO 


o oo> 
































co 


_ 












l« 






































CO 


oa t-» o* co co co 






































lOW* 












M»hhiONN 






































cor<* 








"«* 




»-h NN 


t- 






CO 
















r~ 




n e 






;^ 










<N<M 






OQ 




CM 


« 


o 














go o cot>- 














r^. oo co 






















COCN *- 


O 0OOi»O 


-co 






oo w 


•^ 


oo 


iOO»-t 




O t-*u5 






-t< 














T-IOI 




















CO 
















-tn r- 
















t*- m* r— 
















































o *o CO o 




■^ 




re -rr 


OS rp 


co»oeM 

C*J COCO 


•CO 


co*-***- c© 10 








Tj<CO^ 


•<J« 










CO—t OCO 


















iO I s - 






o- 




t^t^ 










































co ~* *o cc 






o oo 10 




CD CO 


OOb- 


•* 






































WlOW-H 


•CO 


CO 








10 10 1-1 


CO 






































NM 






^* *o 






~ 


CI 
























C 




■«* 


t>- t>» 


^ 


h« 


"■^i 








^ 


r» 


r* 












t* t>* t-- I s - r^- 
















































7 






oo 


N 


o 










l^^H 


CO 


o 




^^owa 






to 


oooo o 










O C 










































o 






-00 


GO Tf ^ C^ Tf< 


<M 




























us u: 








• o 


OiOiO^C-l 






iooooh 


o 






o 






•c io *o 














CM 






mwc^ 












»-H CO 












<M 


«o 






~ 



















»-H COOcD I s - f<- CD CD 

O* *-< O 5D (NCC£>0 



*-t »-.OtO^O!OOO^t 
^NCCNOOJN^WSDWC 
lONOOOHOOOOMt 



•^CDCOCOCD'^t s -. , *-JDCD 
^ONMClOJOOiNN. 
WOOnONNINOOi 



1-1 M N C] 00 •* O CI 
»-h0^h0^hOOO 




5 a m 



90 













k« 




CO 










CO OS COCO N 




CO CO CO co 




COO COCO 




X 9 












iO tr 












^- CO o 


i— n 


^h osO — * 


— »0 cm Os 


S3 












^ c 


o 










oooo< 


— t W3CM O 


O ■■* O t-t 








•- o « E 
































O ft. n 




































CD C" 




CO 




oco co oscoo 


■ CO CO CO CO CO 




CO CO CO 














CO CO 






co co co os co a 


• CO CO CO CO CO 




CO O CO CO 


CO 










coo 


o 




o^-ooo — 


■ CM O NNO 




O ^ i-< CM 


CO 








s°£ 
























CM 










-3 


to 




i-i w 


uo »o • 




>r 




t^, i-4 tM^ 


CO -^ i-i 








Army 
and 
Navy 

officer* 


OS 




OJQ) OS OS 






O 


■ n n ( 


os oo co os cm as 








-a H a 






COf- 










'«»■ 


os *o co n co 

CM 


io *o as co co co 

GO CM CO 






a 




0) 






















"£ 








CO 


CM 






CM ■ 






C*5 


■ »o CM 


CM 


CO IO 


OS 


>> 






<55 






CO 


QO 






00 ■ 






s 


■ -^ CO ■* — CO GO 


coci «r ^* 


i- en 




o 


>> 

> 


Jj 


OB 


o 






o • 






~ 


cM C 


HMOO 


hNNO 
«-H CM 


O 5g 


a 





Es 






























o 


.£Z 


O 




























< 

ft* 


12 "^ 

3 B 




























u 




























B 






























• OS 


TP TP 




N 


-p 








(S| 
























cs 


• o 


O^fO 


iO 


CO *0 N 


"O — 


_3 


a 




11 

< ° 






















xC 


■ CO 


CO N CO 
CM 




CM »-i 


COM 


C 







< 


































BD 










































_: 
























































ON 








»c 


»o O 


[^ 




■-o 




z 




Army 
and 

Navy 
















N-CD 








• oc: 


CO N 


CO 


CO O CO CO 


ro ro 








•o*c 














OlH 








■ O CC 


coco 




co cm ao co 


O TO 


- 


o 




sit 






















:*■* 






'*• 


*■ 


_3 








































< 




s 




































































■x 






n 












-* 1 no 


• n 


Tt* n t^r^ 


N NO 












CO C 










as ■ 






as n as as 


OS Tf OS OS 








o 


>> 




oo 










o ■ 


rtOC^ 


■CO 


HCCOO 


O NO CM 


»o 






H 


bO^ 


Js 


,_; 


















■ ^ 


^ 






S 






























.£Z 


o 




























< 


■2-0 
3. b 






























o 










o ■ 


o 








o 


a 
































s 


• 




TP CO 




00 CM 
















iO 










iO • 


lO 


c 






*oo 


U3 


oco 






iO 








< 


























rt TP 


















^h CC 


C£ 

CO o cc 


CO CZ 

CO CO O r — 


CO CO t> 


coco c* 


^M'J'OOO N N CO t»« 












<M cC 


NNC 


O CO Tt* c 


to CO '-Z 




m « m o ?i x o -t a w m n 












coc 


ooc 


OOOC 


oo>- 


OMC 


MOONOOOO-«CO(N-- 








o 














i-< cM 








H 


















































oo r~ oo co co »« 

o^-oomN 

»-< C4 *-H ~h tt CO 



B b 

p£ 



■as 

. _ ° g 

. CJJftJft E 

2"S *» «» * 



ii;~- 



■a-a 



^ a 



O O fl 



s°as 



o cm 



-3-5 

g „ s 

£ £3 M 



fc >• >. 

c -i ,i 






s a 



3"S P-T3 



s~ 



"2 .2 "2 
'3 '3'3' 



C3 « O 

<;; 3 a > 

o o£ 



. -rg x — , — ^^ 



a a 

1-1 






"O-B 

53 A 



:c "C^'3 
B 'o 'o'o 
o u u « 



!=Sfc,£Q 



2^f 

OQkJC 



■? £ « J&.^ S ;= 



91 







01 


M 


OS 




CO OS 




CO 








1 








uo 








<M ~< 








os os o r-- I o 






O 


o 


cq 




OCN 




— 


WiOOlN *0 






















NMh 1 CD 
























CO 






M 


CO 


CO 






CO o 






OS 








CO 


CO 


cc 






■ CO o 






OS CO OS « 


3 t— 






o 


o 








■coco 






OS O T- 


3 »0 

oo 




«0 lO 


oo 






COCNS 


















Oa OS 


OS COW 


















C£ 


3 ^H 






~* COOS 






uo r^ 












t 
Q 


i o 

1 CO 

CO 






W W CO 








coco 














co co co 














os co -^ a 


S CO 






oo~ 


CO 












C-X OS OS c 


5 lO 

i co 


<M 


en 


oi 








^ 










».o 


o 










Ouo 






W"SNP 


3 OS 








CO 






CO 






t-tO — - \e 


1 *o 

H OO 
CM 






















o 


































-*NN 










C 


) <M 






















CO ** CO 










t- 


o 
































O 


s cc 

CM 






















~^. 






























QO OS 






OOiOC 
























KO-H 






•-< cs os c> 


<M 
















c_ 








o 






DOPJNO 


CO 
























CN 






Oi-.ec- 

— 1 ID JOCC 


OS 


CD CO CO 




CC 








tOCrf^OWT)<C 




co r^ co co cc 




io 




OONO v-hioW 




-hWCOMC 




CC*>"^fCv 


© 


OOOOOOM-C 




Oi^WOC 






s 
















r- couo 






QO CO 






OO 












«OCM 


o 




OOlO 






o 




C\ 


fH 






n «co 


CO 




CM 












OS 

OS 

OS 










c= 


S >o 






o 
























OS 


rr. j- 






CO OS 












- 


OS 










o 


•-o y. 






.-•US 












cs 


CO 
C-1 








































































c 










































o 








































































































































































■o 






























I 










































C3 












"o 
















>> 








































as 

a 












-o 




















f 

c 








'& 


= 








"§ 
























S « 


.2 




~: 


13 






•S 


















E a 


^ 




c« 








S-^' 


Ss. 








c 






i mines and qua 
om agricultural 
inery accidents, 
d automobile co 


^r 


1 

f 1 


X 




•s J p 

a os g 

'="2 c 

ill 

c tj o 


1 


B 

c 




-r 


— 

c 

~ 
c 
"- 



E 
c 


, 




idents ir 
idents fr 
er mach 
[road an 
er railro 
let car a 
omobile 
torcvcle 




"cO_S 


III 




P..5 c £ 

a a-s- 






< 


< 


r 


a! 


— 

s 


5: 


■5 


a 

s 




-3 
S 
v. 


= 


J: 


E 






o 


o 


> 


c 







92 





I 


cm 






© © 


1 °° 


CO 


Tt»Tt<© 


■m 


en 


a 


CO 


»o CI 


i © 


| COC33 


1 CM 


^, . 


r» 


CO CO 


CM 




£ 


© • 




CM CD 


^ 




t^. CM CSS ^ 


— «5 




CM 


■"*■ 


OO-H 1 o 


© " 


■o 


■<Ji t^ 


CO 


CO 

a: 








1 ~ 




"^ 


to 














lO 




OS 






































5 


































CO 










1 






























































<J 




US ■ 






1 <o 




■ CO-* OO 


ce 


CO iO 




— CO 


^< 


1** . 


^ 


CO ■ 


o 


■<** oo 


oo 








CO 


"*• 




•CJfrt 


C-l 
















s 


C0X5 


00 


Q 
a 


13 '3 


















: 






i 












'3 




























'3 

1 


<u rf 


r*- — t ■ 


co o 




•c 


3 ■»-f* 








(NQONO 


CO 






OSC) - 


o>-*p 


^r 




i-<© ■ 


■^ 














CM — 


<* 






—• CO • 


»o 




'-3"S 






























CM 


« 


«3 






















1 : ! 












.m 


OCOMOOO 


■* 


,_, 


- CO^-t ■ 


« 


00 OJ 


Tt« 


Oi OS 


|s 


1 : : 




U0CO CO 


>rae» 


oo 




CO t-hCMtP 










M< 


r^ 










1 ° ^ 


C35CO 


■<*< 




































































pq 


















1 


: ; 










T3 
































c e 


CM 


iOMiQ 


^ 




;^, ; 


- = 


— — 


1 — 


-H OO 


o 


'1 rt : 


i-i 


CO 


^ 


lO-"* 


OS 




.S <*> 






















ci 










CO 


CO 




la'S 




































c3 


££ 
























; 












H 














li 
















d 




1 


























<D C3 


coco 


HU5 








rM 


<M 




MOhO 








»ON • 


cor- 
























OJ C<1 tK 


en 






CM CO 


•* 






-H Jn 






























CM 




h 




































oo 


HOO© 


Ico 


-t* 


- U0CM © 


-II- <N 


1 f ~ 


• o»o 


Ico 


II : — 


^ 


OS 


o 


■^—i 


© 








©CO 


OS 




■ O-h — . 


CO [ 


1 o 


- »^ CO 


■ oa 






CM 


«o 


t~ — 


t^. 




P3 


CO 


Tf OO 


*0 








"* 


• CO CO 


i o 


; 




r*. 




I-* CO 


b- 




m 


rt 


CM* 


-* 






II 




~* 


CM 


i 




IH 




-* 


CD* 


"O 










































©^ 






■CO 


CO 


OS 1 






■ :Oco 








OS 


--= 


»r~ 


OO 










osco 


cs 














■ C-4 ^i 


© 










— o> 




C3 


13 '3 

£<2 






OS 


















N 










— o 


"* 










~ 


















■ 








~ 


- 


S 


















II 














a 
















| 














<D C3 


CM CO 


00 © 


a> 


COl>- "-H ^* 


"3 




COOl^H 


CM 






CO OS 


CO— < 


© 






©s-*r 


-* CO 




oo • 


OS 




i-i OS CO OO 


CD 






-h CJ 


-h CM 


t-* 






i>. <«*< 












»-< CO -^ 


CO 






OS CM 


N CM 


US 




*l 


CM 


■■* 


US 










** 


j 




CO 


CM 


© 






o 


CM "*« CM 


00 


"* 


■ CO »C CO 


iO 




II t^ 


- OSOl 


CO 


■CH 1 S 


-H 




©N 


OS 






t<- 


CO CO 


CO 




■ CM 


CO 






"5 


I>- 




OS 


K 


»o oo 


uo 




C3 






CO 
























CO 




































PQ 










: 




II 
















cc 


CI 


■H *H 1— 1 


>o 


,_, 


•CO 




-f 






II : 


•<M — 


co 




1 : 


CO 


-r 


CO CM 


CO 


T3 


.-.5f 




CM 


(M 






























■<* 




J3 3 






































Q 


Fi= 




















II : 








i 












































O CS 


OS © 


usoo 


00 








M 






-fo- 


^# 








©CO 


U5«* 


r^ 










■^ 


























CM 


o 










































e= a 








: 












il : 


















■5 








: 












II 




1 














-M 


US CO © CO CD 


CO 


r- 


■ CM CM t^- 


CO 


., ^ 


1 r- 


- ^** DO 


csa 


1 CO- 


CO 


OSCOC 




1< 




O i— t^ X 


oo 




• UOCM CM 




cc 


ro 


• ^r o 








— i s 


CO oc 






C3 


"S« TfOS 


CO 












■ CO •«* 


CO 






OS r- 


os-^i 


•rt 


-a 


pq 


-H CM 


"* 












"* 


CO 






r-4 


^ 


!>• 


o a 


^ 


«I>M© 


N 


| ^^ 


•Nr-I« 


Cs» 


»^ c 


CO 


■ a*-** 


so 


CO 


CO 


U0 


■ -~z 


U0 CO 


CO 




-•-= M 




OS © 


T* 




• CM 


CO 






• C-i OS 








OS 


■ •>■ 


CM © 


Ol 








OS 


CM 














Tl 












«1 


'a 

-a 






1 
























~ 


- 


< 








I 


























si 


CM CO 


us© 


O 


CO CO • i— 1 t>» 


•^ 






OS **< CO CO 


U5 


: 




*■*• © 


CM CO 


o 




or- 


us r^. 


© 


oo - 


c^ 






COCO O CM 


CO 






Tt< OS 


CM © 


LO 




•2 o 

&a 


cc-^ 




CM 










— GO "S 


iO 






OS CO 


CM CO 


oo 




cm" 


IH 


us 


1 : 










— 






CO 


CM* 


tts 




-5 








1 














• 








CO 




us 




f*-oo 


© 


oo 


■ CO© CD 


r~ 


i-t r- 


-* 


■ 0)0 


CO 


t~c 


J t- 


b- 


c 


) ■^Tt* 


»o 


C» 


.y 


!>. 










© CM f- 




CM ^ 




CO 


■a 


C^ (> 


os 


© 




3 CO CM 


•^ 


oa 






*-i 


CM 






M5 














'""' 


T 


y~t CM 


ea 


^ 


pq 




































>> 

3 










































































a> c 


US 




©us 


CO 




-C5©OS 


S3 


CO c 


: 




CO 


c^ 


CM 


CO 




COIQ 


"» 


*j bC 






cm 


CO 




• 00«-i *-■ 


















■ C7 


CM "<* 




a 


lc'3 














'- , 




















rH 


1-5 

to 


£<£ 




































a 
.3 




































U C3 


OS»0 


■ iCC 


CO 


• 


N. ,-H .O 


CO 






TP^— OS 


00 






CO CO 


Neo 


o 






»-h OS 


CM 


"* 














CO 






CM CM 


•^ 




1 


2'g 


























^ H 




*^ 


tf 


H 






1 




























m 


1 






















: ~2 


















•T3 








"S 
















• ^ 








; ca 










■si 








J ffS 








08 




>. o 








^ 








;"3 




h 








• 




52 




-^ 




a 




^O 








So 








-3 


I '• 


> 

C3 






6° 




: 


3a 




"o 




c 
o 

Bg 

P3 


■3 a 
'§■' 

Si 

s8|£ 


•8'g 

•si! 

-all 


3 

< 


3 

o 


'E v 

Ip 


2:3 

S a 

■5P-C 


j O 


"o 


i 


: a" 

JO 


s -f 1 
k a 

aH 
o 


c 

Si 

3c 


< 


3 

c 


O C3 
O 


1? o 

i 

5 


'u ° 

3«- 


!i 

-■ - 

3(i 




-a 

a 

d 

3 




B 


s 




o 


o 




c3 


o 










o 












O 












O 








&H 




t-l 











93 



Table 10— NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED AND AVERAGE NUMBER IN 
HOSPITAL EACH DAY OF THE VARIOUS CLASSES OF PATIENTS, 1932 





Number of days treatment 


Average number in 


hospital each day 


Class of patients 


Ameri- 
can 


Foreign 


Black 


Total 


Ameri- 
can 


Foreign 


Black 


Total 


Gorgas Hospital: 


7,205 

39,934 

2,053 


2,846 


21,553 


31,604 
39,934 
2,053 
275 
10,064 
65,882 


19.69 

109.11 

5.61 

6.46 
38.69 


7.77 


58.89 


86.35 




109.11 












5.61 




29 
1,923 
12,968 


246 
5,775 
38,755 


.08 

5.25 

35.43 


.67 
15.78 
105.89 


.75 




2,366 
14,159 


27.50 




180.01 






Total 


65,717 


17,766 


66,329 


149,812 


179.55 


48.54 


181.23 


409.32 






Corozal Hospital: 


134 

2,996 

165 


401 


8,774 


9,309 
2,996 
165 
189,181 
12,829 
38,760 


.37 

8.19 

.45 

1.08 
3.51 


1.09 


23.97 


25.43 




8.19 












.45 




34,387 
3,848 
6,840 


154,794 

8,587 

30,634 


93.95 
10.51 
18.69 


422.93 
23.46 
83.70 


516.89 




394 

1,286 


35.05 




105.90 






Total 


4,975 


45,476 


202,789 


253,240 


13.59 


124.25 


554.07 


691.91 






1,241 
1,115 


7,544 
21,902 


8,785 
23,017 




3.39 
3.05 


20.61 
59.84 


24.00 






62.89 








Colon Hospital: 


938 

7,744 

696 

3,477 

12,855 


129 


5,097 


6,164 
7,744 
4,424 
17,047 


2.56 

21.16 

1.90 

9.50 


.35 


13.93 


16.84 




21 16 




277 

1,467 


3,451 
12,103 


.76 
4.01 


9.43 
33.07 


12 09 




46.58 






Total 


1,873 


20,651 


35,379 


35.12 


5.12 


56.42 


96.66 






Palo Seco Leper Colony: 




1,095 


30,539 
6,909 


31,634 
6,909 




2.99 


83.44 


86.43 






18.88 
















Total 




1,095 


37,448 


38,543 




2.99 


102.32 


105 31 








Total by classes: 


8,277 

50,674 

2,218 

3,456 
18,922 


3,376 


35,424 


47,077 

50,674 

2,218 

221,090 

66,028 
121,689 


22.61 

138.45 

6.06 

9.44 
51.70 


9.22 


96.79 


128.62 




138 45 












6 00 


Canal Zone Government, charity, 


35,511 

8,404 
21,275 


185,579 

54,168 
81,492 


97.02 

22.96 
58.13 


507.05 

148 00 
222.65 


604.07 
180.40 




332.48 








83,547 


68,566 


356,663 


508,776 


228.27 


187.34 


974.49 


1,390 10 







Table 11.— CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPENSARIES, 1932 



All classes of patients 


White 


Black 


Total 


Admissions to hospitals, excluding Corozal farm (cripples and chronic ward) 


8,385 
3,102 


7,443 
3,208 


15,828 
6,310 








11,487 


10,651 


22,138 






Less number of patients transferred between hospitals and from quarters to hos- 


220 


240 


460 








11,267 


10,411 


21,678 






Employces only 


1,139 
3,102 


1,919 
3,208 


3,058 




6,310 








4,241 


5,127 


9,368 






Less number transferred between hospitals and from quarters to hospitals, whose 


56 


156 


212 








4,185 


4,971 


9,156 








1,235.61 


538.34 


725 46 







94 



Table 12.— REPORT OF DISPENSARIES, 1932 

EMPLOYEES TREATED IN QUARTERS 



Dispensary 


Remaining 

January 1, 

1932 


Admitted 


Died 


Discharged 


Transferred 


Remaining 
December 
31, 1932 




White 


Black 


White 


Black 


White 


Black 


White 


Black 


White 


Black 


White 


Black 




4 

4 


9 
6 
3 

'25' 


749 
1,190 
291 
151 
693 
28 


926 
565 
383 
210 
1,027 
97 






724 
1,188 
291 
150 
688 
28 


877 
568 
380 
210 
1,026 
96 


28 


46 


1 
5 


12 




1 




3 




1 




5 








1 

8 






3 










26 






1 






















Total .' 


11 


43 


3,102 


3,208 


1 


2 


3,069 


3,157 


2S 


51 


15 


41 






Dispensary furnishing treatment 


Days treatment furnished 


Average number treated 
in quarters per day 




White 


Black 


Total 


White 


Black 


Total 




1,814 
3,321 
1,175 
461 
2,679 
48 


4,994 
2,737 
2,194 
1,072 
9,726 
286 


6, SOS 
6,058 
3,369 
1,533 
12,405 
334 


4.96 
9.07 
3.21 
1.26 
7.32 
.13 


13.64 
7.48 
5 99 
2.93 

26.57 
.78 


18 60 




16 55 




9 20 




4.19 




33 89 




91 






Total '. . .. 


9,498 


21.009 


30,507 


25.95 


57 40 


S3 35 

























ALL CASES TREATED 



Dispensary 


Employees 


Nonemployees 


Total 


White 


Black 


Total 


White 


Black 


Total 


White 


Black 


Total 


Ancon 


6,415 
10,255 
4,577 
3,705 

8.85S 
'4.99S 


17,520 
12,746 
8,139 
5,686 
13,823 
> 7,740 


23,935 
23,001 
12,716 
9,391 

22,681 
12.73S 


7,345 

15,613 

8,521 

4,893 

13,970 

3 2,381 


18,860 
12,631 
15,375 

7,874 
19,744 
"1,698 


26,205 
28,244 
23,896 
12,767 
33,714 
4,079 


13,700 
25,868 
13,098 

8,598 
22.82S 

7,379 


36,380 
25,377 
23,514 
13,560 
33,567 
9,438 


50,140 
51,245 




36,612 


Gatun 

Colon 

Madden Dam 


22,158 
56,395 
16,817 


Total 


38, SOS 


65,654 


104,462 


52,723 


76.1S2 


128,905 


91,531 


141,836 


233,367 



■Includes 3,923 contractors' employees. » Includes 5,72S contractors' employees. ' Includes 1,5 
families of contractors' employees. * Includes 927 members of families of contractors' employees. 



1 members of 



Table 13.— AVERAGE NUMBER OF DAYS IN HOSPITAL AND QUARTERS FOR EACH ADMISSION, 

EMPLOYEES ONLY, 1932 





White 


Black 


Total 


Hospitals: 


10.78 

8.27 


21.80 
12.05 


17.24 




11.17 








10.49 


19.53 


16.09 






Quarters: 


2.42 
2.79 
4.04 
3.05 
3.87 
1.71 


5.39 
4.84 
5.73 
5.10 
9.47 
2.95 


4.06 




3.45 




5.00 




4.25 




7.21 




2.67 








3.06 


6.55 


4.83 







MR 35955— Panama Canal— 1-3-34— 1,000